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13 - Cost-effectiveness analysis for carotid imaging

from Luminal imaging techniques

Published online by Cambridge University Press:  03 December 2009

By
Jean Marie U-King-Im ,
William Hollingworth  and
Jonathan H. Gillard
Edited by
Jonathan Gillard ,
Martin Graves ,
Thomas Hatsukami  and
Chun Yuan
Jean Marie U-King-Im
Affiliation:
Addenbrooke's Hospital and the University of Cambridge, UK
William Hollingworth
Affiliation:
University of Washington, Seattle, WA 98103, USA
Jonathan H. Gillard
Affiliation:
Addenbrooke's Hospital and the University of Cambridge, UK
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
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Summary

Introduction

The pooled analysis of data from large randomized trials such as the North American symptomatic carotid trial (NASCET) and the European carotid surgery trial (ECST) has confirmed the significant benefits of surgery for severe (70–99%) carotid stenosis in recently symptomatic patients (Rothwell et al., 2003). Moreover, in asymptomatic patients, 60% stenosis is generally used as a cut-off for surgery based on the results of the asymptomatic carotid atherosclerosis study (ACAS) (Endarterectomy for asymptomatic carotid artery stenosis. Executive Committee for the Asymptomatic Carotid Atherosclerosis Study, 1995). In most of these trials, intraarterial digital subtraction angiography (DSA) has been used to measure the degree of stenosis and as such, remains the gold standard method in terms of diagnostic accuracy, against which alternative imaging modalities need to be validated. Concerns about the small but potentially significant risks of neurological complications associated with DSA have generated a strong trend toward the use of noninvasive modalities such as Doppler ultrasound (DUS), magnetic resonance angiography (MRA) or computerized tomography angiography (CTA) alone or in combination (Dawson et al., 1997; Athanasoulis and Plomaritoglou, 2000; Long et al., 2002).

In current clinical practice, there is ongoing controversy whether noninvasive strategies can replace DSA as the preoperative imaging modality of choice (Derdeyn and Powers, 1996; Davis and Donnan, 2003). This lack of consensus is reflected by a wide variety of existing practices worldwide (Dawson et al., 1997; Athanasoulis and Plomaritoglou, 2000; Long et al., 2002; Willinsky et al., 2003).

Keywords

asymptomatic carotid atherosclerosisasymptomatic patientscarotid imagingcost-effectiveness decision analysisstenosiseconomic analyses
Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
 , pp. 166 - 179
Publisher: Cambridge University Press
Print publication year: 2006

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