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CT angiography for diagnosis of carotid near-occlusion: a digital subtraction angiography validation study

  • Diagnostic Neuroradiology
  • Published:
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Abstract

Introduction

Carotid near-occlusion (CNO) is a variant of severe stenosis where there is a distal luminal collapse of the internal carotid artery (ICA) beyond a tight stenosis. This study aimed to validate new visual extracranial diagnostic CT angiography (CTA) criteria, for the diagnosis of CNO. The new criteria include distal ICA diameter smaller than contralateral ICA and distal ICA diameter less than or equal to the ipsilateral external carotid artery (ECA). We also assessed the previously described CTA criteria: stenosis ≤ 1.3 mm, ipsilateral distal ICA ≤ 3.5 mm, ipsilateral distal ICA/contralateral distal ICA ratio ≤ 0.87, ipsilateral distal ICA/ipsilateral ECA ≤ 1.27.

Methods

Fifty-eight patients with ICA stenosis (including the near-occlusion variant) or occlusion on digital subtraction angiography (DSA) were included. These patients had DSA and CTA studies completed within 30 days of each other. DSA was considered the reference test. Two neuroradiologists blinded to the DSA results assessed the CTA images and evaluated the new and previously published CNO diagnostic criteria.

Results

Twenty-eight CNO were identified with DSA. The “distal ICA diameter less than or equal to the ipsilateral ECA” criterion had 79% sensitivity and 83% specificity with excellent interobserver agreement (kappa = 0.80), while three or more of the previously published criteria reached 82% sensitivity and 90% specificity, with a good interobserver agreement (kappa = 0.64).

Conclusions

CT angiography may be useful for CNO diagnosis. The new visual diagnostic criteria provide acceptable results of sensitivity and specificity with an excellent interobserver agreement. However, false-negative and positive results persist.

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Abbreviations

CNO:

Carotid near-occlusion

ICA:

Internal carotid artery

ECA:

External carotid artery

DSA:

Digital subtraction angiography

CTA:

Computed tomography angiography

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Acknowledgements

We thank Dr. Pedro José Borrego Ruiz for helping with acquisition and procesing of data.

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Authors and Affiliations

  1. Interventional Neuroradiology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain

    Martiel Manrique-Zegarra

  2. Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Andrés García-Pastor

  3. Interventional Neuroradiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Enrique Castro-Reyes, Mariano Del Valle Diéguez, Fernando Fortea Gil, Jorge González Cantero & Javier Saura Lorente

  4. Neuroradiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    Juan A. Guzmán-De-Villoria, Isabel Herrera Herrera & Irene Garrido Morro

Authors
  1. Martiel Manrique-Zegarra
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  2. Andrés García-Pastor
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Corresponding author

Correspondence to Martiel Manrique-Zegarra.

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We declare that we have no conflict of interest.

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Ethics approval was obtained from the ethics committee of Gregorio Marañón University Hospital.

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The abstract was presented as an e-poster in the ESOC meeting 2021.

All the authors were part of the multidisclipinary team of the stroke center Hospital General Universitario Gregorio Marañón.

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Manrique-Zegarra, M., García-Pastor, A., Castro-Reyes, E. et al. CT angiography for diagnosis of carotid near-occlusion: a digital subtraction angiography validation study. Neuroradiology 64, 1729–1735 (2022). https://doi.org/10.1007/s00234-022-02995-w

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  • DOI: https://doi.org/10.1007/s00234-022-02995-w

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