目的:本研究旨在验证多普勒超声对无名,锁骨下,和颈总动脉狭窄.
方法:这项回顾性多中心研究在2013年至2022年期间纳入了636例接受颈动脉多普勒超声检查和随后的数字减影血管造影的患者。58个无名动脉狭窄,147颈总动脉狭窄,包括154例锁骨下动脉狭窄。无名时的收缩期峰值速度,锁骨下,和颈总动脉,无名动脉与颈总动脉的速度比,锁骨下动脉无名动脉,测量或计算颈总动脉至颈内动脉。使用接收器操作特性分析确定阈值。
结果:无名动脉狭窄的阈值为收缩期峰值速度>206cm/s(灵敏度:82.8%;特异性:91.4%)预测≥50%狭窄和>285cm/s(灵敏度:89.2%;特异性:94.9%)预测≥70%狭窄。颈总动脉狭窄的阈值为收缩期峰值速度>175cm/s(敏感性:78.2%;特异性:91.9%)预测≥50%狭窄和>255cm/s(敏感性:87.1%;特异性:87.2%)预测≥70%狭窄。锁骨下动脉狭窄的阈值为收缩期峰值速度>200cm/s(敏感性:68.2%;特异性:84.4%)以预测≥50%的狭窄和>305cm/s(敏感性:57.9%;特异性:91.4%)以预测≥70%的狭窄。
结论:无名动脉超声参数≥206cm/s的症状患者,颈总动脉速度≥175cm/s,或锁骨下动脉的速度≥200cm/s需要考虑进一步验证以及是否需要血运重建。
OBJECTIVE: This study aimed to validate the efficiency of Doppler ultrasonography for predicting the innominate, subclavian, and common carotid artery stenosis.
METHODS: This retrospective multicenter study between 2013 and 2022 enrolled 636 patients who underwent carotid Doppler ultrasonography and subsequent digital subtraction angiography. And 58 innominate artery stenosis, 147 common carotid artery stenosis, and 154 subclavian artery stenosis were included. The peak systolic velocity at innominate, subclavian, and common carotid artery, and velocity ratios of innominate artery to common carotid artery, innominate artery to subclavian artery, and common carotid artery to internal carotid artery were measured or calculated. The threshold values were determined using receiver operating characteristic analysis.
RESULTS: The threshold values of innominate artery stenosis were peak systolic velocity >206 cm/s (sensitivity: 82.8%; specificity: 91.4%) to predict ≥50% stenosis and >285 cm/s (sensitivity: 89.2%; specificity: 94.9%) to predict ≥70% stenosis. The threshold values of common carotid artery stenosis were peak systolic velocity >175 cm/s (sensitivity: 78.2%; specificity: 91.9%) to predict ≥50% stenosis and >255 cm/s (sensitivity: 87.1%; specificity: 87.2%) to predict ≥70% stenosis. The threshold values of subclavian artery stenosis were peak systolic velocity >200 cm/s (sensitivity: 68.2%; specificity: 84.4%) to predict ≥50% stenosis and >305 cm/s (sensitivity: 57.9%; specificity: 91.4%) to predict ≥70% stenosis.
CONCLUSIONS: Symptomatic patients with ultrasonic parameters of velocity at innominate artery ≥206 cm/s, velocity at common carotid artery ≥175 cm/s, or velocity at subclavian artery ≥200 cm/s need to be considered for further verification and whether revascularization is necessary.