Rapid screening for carotid disease

Abstract

Objective: Identifying patients with significant carotid disease by history and physical examination is notoriously inaccurate. Duplex scanning is accurate, but time-consuming, costly, and typically most of the patients referred for evaluation do not have significant carotid disease.Methods: In a prospective study, 331 patients referred for suspicion of carotid disease were screened for significant carotid artery pathology using an abbreviated 3–10 minute examination. The examination consisted of common, internal, and external carotid artery screening using 2D, color Doppler, and power color Doppler. Each screening examination was interpreted as + or −; patients could have all 3 screens negative (none) ranging to all positive (3+). All patients subsequently received a full carotid duplex examination with the results classified as normal, 40–59% (mild), 60–79% (moderate), 80–99% (severe) stenosis.Results: In the studied group, 228 (69%) patients were normal, 41 (12.4%) had mild stenosis, 40 (12.0%) had moderate stenosis, 22 (6.6%) had severe stenosis. All patients with severe and 39/40 (97.5%) of patients with moderate stenosis were identified by positive results on 2 or more screening tests. All negative screens were only seen in normal (63/228; 27.6%) and low-grade stenosis patients (2/41; 4.9%). Using no more than one screen positive as the criteria for further study would identify 137/228 (60.1%) of normals and 7/41 (17.1%) with mild stenosis. Although it failed to identify 1/40 (2.5%) of patients with moderate stenosis, it did not miss any patients with severe stenosis 0/22 (0%).Conclusions: A preliminary screening prior to a full duplex scan appears to be cost-effective. Depending on the availability of resources, an all negative screen or no more than one positive screen may eliminate the need for a complete examination in a substantial number of patients. Tabled 1NormalsMild 40–59%Moderate 60–79%Severe 80–99%All negative63200One positive74510Two positive6525114All positive2692818total228414022 Open table in a new tab Objective: Identifying patients with significant carotid disease by history and physical examination is notoriously inaccurate. Duplex scanning is accurate, but time-consuming, costly, and typically most of the patients referred for evaluation do not have significant carotid disease. Methods: In a prospective study, 331 patients referred for suspicion of carotid disease were screened for significant carotid artery pathology using an abbreviated 3–10 minute examination. The examination consisted of common, internal, and external carotid artery screening using 2D, color Doppler, and power color Doppler. Each screening examination was interpreted as + or −; patients could have all 3 screens negative (none) ranging to all positive (3+). All patients subsequently received a full carotid duplex examination with the results classified as normal, 40–59% (mild), 60–79% (moderate), 80–99% (severe) stenosis. Results: In the studied group, 228 (69%) patients were normal, 41 (12.4%) had mild stenosis, 40 (12.0%) had moderate stenosis, 22 (6.6%) had severe stenosis. All patients with severe and 39/40 (97.5%) of patients with moderate stenosis were identified by positive results on 2 or more screening tests. All negative screens were only seen in normal (63/228; 27.6%) and low-grade stenosis patients (2/41; 4.9%). Using no more than one screen positive as the criteria for further study would identify 137/228 (60.1%) of normals and 7/41 (17.1%) with mild stenosis. Although it failed to identify 1/40 (2.5%) of patients with moderate stenosis, it did not miss any patients with severe stenosis 0/22 (0%). Conclusions: A preliminary screening prior to a full duplex scan appears to be cost-effective. Depending on the availability of resources, an all negative screen or no more than one positive screen may eliminate the need for a complete examination in a substantial number of patients. Tabled 1NormalsMild 40–59%Moderate 60–79%Severe 80–99%All negative63200One positive74510Two positive6525114All positive2692818total228414022 Open table in a new tab