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  • E-253 Correlation of CT angiography to digital substraction angiography in carotid stenosis with real-world assessment of overestimation of CS on CTA

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SNIS 21st annual meeting electronic poster abstracts
E-253 Correlation of CT angiography to digital substraction angiography in carotid stenosis with real-world assessment of overestimation of CS on CTA
  1. K El Naamani1,
  2. R Abbas1,
  3. W Chong2,
  4. E Muharremi1,
  5. Y Hai3,
  6. C Morse1,
  7. E Atallah1,
  8. N Herial1,
  9. S Tjoumakaris1,
  10. M Gooch1,
  11. R Rosenwasser1,
  12. A Flanders3,
  13. P Jabbour1
  1. 1Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA
  2. 2Medical Oncology, Thomas Jefferson University Hospital, Philadelphia, PA
  3. 3Radiology, Thomas Jefferson University Hospital, Philadelphia, PA

Abstract

Purpose CTA is the main diagnostic modality and fasle-positive CTA results may expose patients to unnecessary procedural complications. We aim to assess the correlation of CTA to DSA in CS and characterize patients referred for intervention based on CTA who did not require it based on DSA.

Methods We retrospectively reviewed 186 patients who underwent carotid angioplasty and stenting following pre-procedural CTA at our institution from April 2017 to December 2022.

Results Twenty-one of 186 patients (11.2%) were found to have less than 50% carotid stenosis on DSA (discordant group). No clinical covariate was found to be associated with a discordant degree of stenosis, but severe plaque calcification on CTA was associated with a discordant degree of stenosis on DSA (LR+ = 7.4). Among 186 patients, agreement between the percentage of stenosis from CTA and DSA was weak-moderate (r2 = 0.27, p <0.01). When discordant DSA were discarded, we found moderate-strong agreement between CTA and DSA (adj r2=0.37)(p<0.0001). Of 186 patients, 127 patients had CTA stenosis of ≥70%, and 59 had CTA of 50–69%. Correlation between CTA and DSA in severe CTA stenosis was weak (r2=0.11, p <0.01).

Conclusion Of patients with stenosis found on CTA, over 88% also had stenosis on DSA, with this PPV in line with previous studies. The percent-stenosis value from CTA and DSA was weakly correlated but does not affect clinical judgement of stenosis overall. Severe calcification found on CTA may potentially indicate non-stenosis on DSA.

Abstract E-253 Figure 1
Abstract E-253 Figure 1
Abstract E-253 Figure 2
Abstract E-253 Figure 2

Disclosures K. El Naamani: None. R. Abbas: None. W. Chong: None. E. Muharremi: None. Y. Hai: None. C. Morse: None. E. Atallah: None. N. Herial: None. S. Tjoumakaris: 2; C; MicroVention. M. Gooch: 2; C; Stryker. R. Rosenwasser: None. A. Flanders: None. P. Jabbour: 2; C; Medtronic, MicroVention, Cerus Endovascular, Balt.

https://doi.org/10.1136/jnis-2024-SNIS.358

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