The Comparative Study Of Carotid Artery Ultrasound With Angiography In Patients With Carotid Atherosclerosis

PARTⅠTHE COMPARATIVE STUDY OF CAROTID ARTERY ULTRASOUND WITH ANGIOGRAPHY IN PATIENTS WITH CAROTID ATHEROSCLEROSISObjective:To compare the advantages and shortcoming of carotid artery ultrasound with digital subtraction angiography(DSA) of carotid in diagnosis of carotid atherosclerosis. To investigate the clinical value of ultrasound in diognosis of carotid atherosclerosis and the best adaptation.Methods: 126 cases with more than two dangerous factors of carotid atherosclerosis were examed with carotid artery ultrasound and carotid DSA. We observed inside diameter, intima-media thickness of carotid artery, character and positon of plaque, stenosis and calculate the ratio of stenosis.Results:The incidence of the left carotid plaque was higher than that of the right. The most plaques of the bifurcation of carotid artery were found than the others. The plaques of main carotid and interior carotid artery were secondary. The incidence of plaque and (or) stenosis of carotid in aged patients were diagnosed by ultrasound and DSA were 60.32%, 53.97% respectively.The rate of stenosis with carotid artery ultrasound and carotid DSA were 43.5%±0.6% vs 46.5%±0.75%. Taking DSA as a golden standard, the sensitivity ,specificity ,positive predictive value, negative predictive value of carotid artery ultrasound was 83.82%,67.24%,78.89%,78% respectively. Youden index was 0.518. Positive likelihood ratio, negative likelihood ration was 2.56, 0.24, respectively.Conclusions: Carotid artery ultrasound has high sensitivity in diagnosis of carotid atherosclerosis, but specificity is lower. Either Carotid artery ultrasound or angiography has advantages and shortcoming. We could find more carotid plaques with ultrasound than angiography, and could observe inside diameter, intima-media thickness and hemodynamics of carotid artery, character and positon of plaque, stenosis and calculate the ratio of stenosis. If we combinate the two methods, there will be an important significance in diagnosis, clinical treatment, observation before operation and follow-up after operation in patients with carotid atherosclerosis.PARTⅡPERIPHERAL ARTERIAL ATHEROSCLEROSIS AND CORONARY HEART DISEASE IN AGED GROUPObjective: To investigate the relationship between peripheral arterial atherosclerosis and coronary heart disease (CHD) in aged group, safety and feasibility of inspecting multi-position blood vessels in one angiography.Methods: 172 patients who underwent coronary angiography were recruited in this study. After coronary angiography, 172 patients were divided into 4 groups according to the number of injured vessels: normal group(n=50), single vessel group(n=51), double vessel group(n=34), triple vessel group(n=51). One week before coronary angiography,carotid artery ultrasound was conducted. Meanwhile the patients'characteristics were recorded,which included the blood pressure, the chemical and blood lipoid, fibrinogen and c-reactive protein. (2)126 cases with more than two dangerous factors of atherosclerosis were perfomed with carotid, Vertebral, Subclavian artery Angiography, 82 were perfomed with renal angiography, 2 cases lower limb artery angiography. The time of angiography and x-ray exposure , dose of medicine ,renal function before and after operation and complication were recorded.Results: 1.There were no difference for sexuality, smoking, diastolic pressure, high density lipoprotein(HDL), low density lipoprotein(LDL) and fasting blood sugar between normal group and each disease group. Age, systolic pressure, cholesterol, triglyceride, fibrinogen and c-reactive protein in disease group were higher than in normal group. 2. 113 patients were detected IMT increasing and plaques by ultrasound of 122 cases which by angiography. 21 patients were normal by ultrasound of 50 cases by angiography. 3. Single vessel group were primary of IMT and plaque.Triple vessel group wew primary of plaque and stenosis. 4.There were difference for IMT,plaque area ,scores and numbers of plaque between normal group and each disease group obviously(P<0.01). Areas and scores of plaque were much more in double and triple vessel group than single vessel group. 5. Taking IMT as a dependent variable in a multiple stepwise regression analysis, age, systolic pressure and fg were independently correlated with IMT. TC, 2hPBG and systolic pressure were correlated with areas of plaque. Age was correlated with scores of plaque. IMT, fg, areas of plaque, systolic pressure, 2hPBG and scores of plaque were correlated with coronary disease. 6. The incidence of stenosis of coronary ,carotid, subclavian, vertebral ,renal artery were 70.93%,44.47%,20.63%,7.94%,46.34% respectively. Time of operation and x-ray exposure and dose of medicine in multi-position angiography were more than single position, but complication in and after operation did not increase. There were no difference for blood Creatinine between before and after operation.Conclusion: 1. IMT, index, areas and scores of carotid plaque in each CHD group were more than normal group. 2. The more carotid atherosclerosis was serious, the more coronary vessels were involved. 3. It was safe and feasible in aged people for angiography with coronary and peripheral artery one time. It could enhance diagnosis ratio of multi-position vessel disease. We could deal with the most dangerous vessel.