DEGREE OF CAROTID-ARTERY STENOSIS - COMPARISON OF SELECTIVE AND NONSELECTIVE ANGIOGRAPHIC FINDINGS WITH SURGICAL SPECIMENS

Objective: To compare the degree of vessel narrowing seen on selective and non-selective carotid artery catheter angiograms using criteria s et by NASCET and ECST with the results obtained from corresponding sur gical specimens. Subjects: In 40 preoperative angiograms (20 non-selec tive, 20 selective) the 'distal' degree of internal carotid artery (IC A) stenosis according to NASCET criteria and the 'local' degree of ste nosis according to ECST criteria was assessed. These data were compare d with the 'distal' and 'local' degree of ICA stenosis obtained by mea suring the specimens and the diameter of the distal ICA intraoperative ly. Results: The median 'local' degree of stenosis was 86.5% in the sp ecimen and 83.5% in the selective angiograms (difference not significa nt). In non-selective angiography the median 'local' degree of stenosi s was 77.5% compared to 84% in the corresponding specimens (P < 0.01). The median 'distal' degree of stenosis in selective angiography was 7 6.5 versus 75.5% in the specimens (n.s.). The median 'distal' degree o f non-selective angiography was 67% compared to 77.5% in the correspon ding specimens (P = 0.02), The trend to underestimate high grade steno sis (above 90%) was more pronounced in non-selective than in selective angiography. Medium grade stenosis (60-80%) was slightly overestimate d in selective angiography. Conclusion: Selective angiography is more accurate in determining the 'true' degree of stenosis in internal caro tid artery disease, taking into account a slight overestimation of med ium grade stenosis, High grade stenosis is underestimated in both sele ctive and non-selective angiography, These observations extend to both the ECST and NASCET criteria of measuring the degree of stenosis, whi ch differ by about 10%. (C) 1997 Elsevier Science Ireland Ltd.