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Diagnosis of Carotid Arterial Occlusive Disease

Reliability of Combined Carotid Phonoangiography and Oculoplethysmography

Section of Cardiovascular Surgery, Arizona Heart Institute, Phoenix, Arizona

Edward B. Diethrich, M.D., F.A.C.A.

Section of Cardiovascular Surgery, Arizona Heart Institute, Phoenix, Arizona

Edward B. Diethrich, M.D., F.A.C.A.

Section of Cardiovascular Surgery, Arizona Heart Institute, Phoenix, Arizona

A retrospective analysis of 1500 patient records was performed to assess the validity and reliability of combined oculoplethysmography and carotid phonoangiography (OPG/CPA) as indicators of carotid arterial occlusive disease. The tests were interpreted by means of a five-level grading system based on percentage of flow reduction. Reliability statistics were calculated by using arteriography as a comparison in 10% (152) of the patients.

Of the 1500 tests, 477 (32%) were abnormal, but only 252 (17%) were graded as hemodynamically significant (levels II-V). Arteriography confirmed total carotid occlusion in 16 of 19 (84%) grade V patients; the remaining 3 (16%) had significant stenosis but on a less severe level (III or IV). In the inter mediate grade II-IV results, 39 of 44 (89%) were accurate; 2 (4%) false positive and 3 (7%) overestimated cases were in this group. In the normal- grade I patients, 81 of 89 (91%) interpretations were confirmed. The false negatives (9%) in the latter group were attributable to nonstenosing ulcera tive plaques (6 patients) and moderately significant stenosis (2 patients). Overall reliability was 90%, with 1% false positives, 4% false negatives, and about 5% erroneous assessment of severity within the abnormal grades II-V. Thus OPG/GPA testing is a valuable, reliable, noninvasive screening and diagnostic tool for carotid disease detection, but it is sensitive only to stenotic lesions, not to ulcerative plaques.

Vascular and Endovascular Surgery, Vol. 14, No. 1, 23-29 (1980)
DOI: 10.1177/153857448001400106


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