Review: Noninvasive imaging techniques may be useful for diagnosing 70% to 99% carotid stenosis in symptomatic patients

摘要

The results of the review by Wardlaw and colleagues are unsettling,ngiven the emerging status quo of relying only on noninvasive techniquesnbefore proceeding to carotid endarterectomy (CEA) (1). First, itnis likely that in routine clinical practice the sensitivity and specificity forndetecting severe stenosis (70% to 99%) are considerably lower thannwhat the authors report. Second, even under the best of circumstances,nCTA may miss 1 in 5 severe stenoses and DUS or MRA may result inninappropriate surgery on 1 in 7 patients. Third, the abysmal sensitivitynand specificity of DUS and MRA in detecting moderate stenosis (50%nto 69%) suggests that patients may be unconsciously downgraded ton0% to 49% or upgraded to 70% to 99% stenosis.