The application of 64 multidetector CT angiography in the evaluation of carotid stenosis and follow-up of carotid endarterectomy and percutaneous transluminal stenting

Objective: To evaluate the diagnostic value of 64 multidetector-row CT angiography for internal carotid artery (ICA) stenosis and the application in the follow-up of carotid endarterectomy and percutaneous transluminal stenting. Methods: Forty transient ischemic attack (TIA) patients with interpretable CTA and DSA of the cervical carotid arteries were selected from May 2005 to December 2005. This yielded a total of 80 vessels. The CTA curved planar reformations (CPR) and DSA images referenced to the distal cervical internal carotid were graded by two senior neuroradiologists blindly, according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) guidelines. The paired-t test was used to verify the statistical significant difference between pre-operating and post-operating of carotid endarterectomy or percutaneous transluminal stenting in measuring the vascular diameter and area of cross section using CTA. Results: When the 70% stenosis was used as the cut-off value, the sensitivity, specificity, negative predictive value, and the positive predicting value were 97%, 95%, 95%, and 98%, respectively. There was statistically significant difference in measuring the vascular diameter (P<0.01) and area of cross section (P<0.01) before and after carotid endarterectomy or percutaneous transluminal stenting. Conclusions: From the comparative study between CTA and DSA examination of head and neck, CTA was proved to have high sensitivity, high specificity, high negative and positive predictive value for carotid disease. CTA appears to be an excellent screening test for internal carotid stenosis and could be used for the follow-up of carotid endarterectomy and percutaneous transluminal stenting. (authors)