Diagnosis of Carotid Artery Stenosis with Oculopneumoplethysmography Alone and in Combination with MRA

Overview

Journal Vasc Health Risk Manag

Publisher Dove Medical Press

Specialty Cardiology & Vascular Diseases

Date 2012 Dec 5

PMID 23209371

Citations 1

Authors

Richard M Elias

John T Wald

David F Kallmes

Affiliations

Soon will be listed here.

Abstract

Background: The purpose of this study was to assess the accuracy of oculopneumoplethysmography (OPG) for the diagnosis of carotid artery stenosis both alone and in conjunction with carotid magnetic resonance angiography (MRA).

Methods: This retrospective study reviewed patients who had undergone both OPG and digital subtraction angiography (DSA, 90 patients, 174 vessels) within two weeks to determine the accuracy of OPG with DSA as the reference standard for the detection of carotid artery stenosis. Three carotid artery stenosis thresholds (≥50%, ≥70%, ≥80%) were analyzed. The accuracy of the combination of OPG and MRA was analyzed in a subset of patients who underwent OPG and MRA and DSA (53 patients, 94 vessels).

Results: The sensitivity and negative predictive value of OPG increased with higher-degree carotid artery stenoses, and for lesions ≥ 80%, these values were 85.3% and 94.2%, respectively. Specificity and positive predictive values were lower at all thresholds, and were 72.9% and 49.3%, respectively, at the ≥80% stenosis threshold. When OPG and MRA were concordant, the sensitivity and specificity for carotid artery stenoses ≥ 80% were 91.0% and 97.8%, respectively. OPG correctly identified 71.4% of false-positive and 80.0% of false-negative magnetic resonance angiographies for that degree of carotid artery stenosis.

Conclusion: OPG appears to be an accurate rule-out test for hemodynamically significant carotid artery stenosis. OPG augments the accuracy of MRA for detection of carotid artery disease.

Citing Articles

Comparative analysis of 3D time-resolved contrast-enhanced magnetic resonance angiography, color Doppler ultrasound and digital subtraction angiography in symptomatic carotid stenosis.

Cui H, Yan R, Zhai Z, Ren J, Li Z, Li Q Exp Ther Med. 2018; 15(2):1654-1659.

PMID: 29434750 PMC: 5774484. DOI: 10.3892/etm.2017.5548.

References

Gee W, Oller D, Wylie E . Noninvasive diagnosis of carotid occlusion by ocular pneumoplethysmography. Stroke. 1976; 7(1):18-21. DOI: 10.1161/01.str.7.1.18. View

Gee W . Ocular pneumoplethysmography. Surv Ophthalmol. 1985; 29(4):276-92. View

Qureshi A, Suri M, Ali Z, Kim S, Fessler R, Ringer A . Role of conventional angiography in evaluation of patients with carotid artery stenosis demonstrated by Doppler ultrasound in general practice. Stroke. 2001; 32(10):2287-91. DOI: 10.1161/hs1001.096613. View

Wiebers D, Folger W, Forbes G, Younge B, OFallon W . Ophthalmodynamometry and ocular pneumoplethysmography for detection of carotid occlusive disease. Arch Neurol. 1982; 39(11):690-1. DOI: 10.1001/archneur.1982.00510230016005. View

Rothwell P, Gibson R, Slattery J, Sellar R, Warlow C . Equivalence of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative Group. Stroke. 1994; 25(12):2435-9. DOI: 10.1161/01.str.25.12.2435. View

Eikelboom B, Riles T, Folcarelli P, Imparato A . Criteria for interpretation of ocular pneumoplethysmography (Gee). Arch Surg. 1983; 118(10):1169-72. DOI: 10.1001/archsurg.1983.01390100043011. View

Gee W, Smith C, Hinson C, Wylie E . Ocular pneumoplethysmography in carotid artery disease. Med Instrum. 1974; 8(4):244-8. View

Criswell B, Langsfeld M, Tullis M, Marek J . Evaluating institutional variability of duplex scanning in the detection of carotid artery stenosis. Am J Surg. 1999; 176(6):591-7. DOI: 10.1016/s0002-9610(98)00287-6. View

Nederkoorn P, Mali W, Eikelboom B, Elgersma O, Buskens E, Hunink M . Preoperative diagnosis of carotid artery stenosis: accuracy of noninvasive testing. Stroke. 2002; 33(8):2003-8. DOI: 10.1161/01.str.0000021900.58396.44. View

10.

Baker J, BARKER W, Machleder H . Evaluation of extracranial cerebrovascular disease with ocular pneumoplethysmography. Am J Surg. 1978; 136(2):206-8. DOI: 10.1016/0002-9610(78)90228-3. View

11.

Gee W, Morrow R, Stephens H, Lin F . Ocular pneumoplethysmography in carotid-cavernous sinus fistulas. J Neurosurg. 1983; 59(1):40-5. DOI: 10.3171/jns.1983.59.1.0040. View

12.

Fisher M . Occlusion of the internal carotid artery. AMA Arch Neurol Psychiatry. 1951; 65(3):346-77. DOI: 10.1001/archneurpsyc.1951.02320030083009. View

13.

Muppala M, Castaldo J . Unilateral supraclinoid internal carotid artery stenosis with moyamoya-like vasculopathy. Noninvasive assessments. J Neuroimaging. 1994; 4(1):11-6. DOI: 10.1111/jon19944111. View

14.

Schwartz J, Flanigan P, Schuler J, Ryan T, CASTRONUOVO J . Indirect assessment of carotid occlusive disease by ocular pneumoplethysmography. 500 mm Hg vacuum pressure measurements and ocular pulse timing. Stroke. 1984; 15(3):521-6. DOI: 10.1161/01.str.15.3.521. View

15.

Gee W, Perline R, MADDEN A . Physiology of carotid endarterectomy with ocular pneumoplethysmography. J Vasc Surg. 1986; 4(2):129-35. DOI: 10.1067/mva.1986.avs0040129. View

16.

Shakin E, Bosley T, Gee W, Reed 3rd J, Brown G, Sergott R . Abnormal ocular pneumoplethysmographic results in unilateral neovascular glaucoma. Arch Neurol. 1989; 46(12):1308-10. DOI: 10.1001/archneur.1989.00520480050019. View

17.

Chen C, Reed 3rd J, Rice D, Gee W, Updike D, Salathe E . Biomechanics of ocular pneumoplethysmography. J Biomech Eng. 1993; 115(3):231-8. DOI: 10.1115/1.2895480. View

18.

Johnston D, Goldstein L . Clinical carotid endarterectomy decision making: noninvasive vascular imaging versus angiography. Neurology. 2001; 56(8):1009-15. DOI: 10.1212/wnl.56.8.1009. View

19.

Gee W . Ocular pneumoplethysmography after lens implantation. J Cataract Refract Surg. 1988; 14(4):417-20. DOI: 10.1016/s0886-3350(88)80151-2. View

20.

Takaya N, Yuan C, Chu B, Saam T, Underhill H, Cai J . Association between carotid plaque characteristics and subsequent ischemic cerebrovascular events: a prospective assessment with MRI--initial results. Stroke. 2006; 37(3):818-23. DOI: 10.1161/01.STR.0000204638.91099.91. View