PURPOSE: Duplex scanning has become the standard for noninvasive evaluation of carotid arteries. However, current ultrasound criteria for internal carotid artery (ICA) stenosis (16% to 49%, 50% to 79%, 80% to 99%) may not be applicable to the categories (30% to 49%, 50% to 69%, 70% to 99%) used in ongoing symptomatic and asymptomatic carotid endarterectomy trials. This study was undertaken to determine new velocity criteria consistent with these categories. METHODS: From January 1, 1989 through October 30, 1992, 5871 color-flow duplex scans were obtained in our laboratories. After inadequate arteriograms and patients with a contralateral ICA occlusion were excluded, 770 peak systolic velocity (PSV) and 229 end-diastolic velocity (EDV) measurements were available for comparison with arteriography. ICA PSV and EDV were subjected to receiver operator characteristic curve analysis to determine optimum criteria for identifying stenoses of 30%, 50%, and 70%. RESULTS: For 70% to 99% carotid artery stenosis, PSV greater than 130 plus EDV greater than 100 provided the best sensitivity (81%), specificity (98%), positive predictive value (89%), negative predictive value (96%), and overall accuracy (95%). For 50% to 69% stenosis, a PSV greater than 130 and EDV of 100 or less cm/sec proved to be the best combination: sensitivity (92%), specificity (97%), positive predictive value (93%), negative predictive value (99%), and accuracy (97%). Stenoses in the 30% to 49% range were less accurately identified. CONCLUSION: These redefined criteria may prove useful for analyzing duplex ultrasound velocity data in reference to the classification of ICA stenosis used in recent clinical trials of the safety and efficacy of carotid endarterectomy.
PURPOSE: Duplex scanning has become the standard for noninvasive evaluation of carotid arteries. However, current ultrasound criteria for internal carotid artery (ICA) stenosis (16% to 49%, 50% to 79%, 80% to 99%) may not be applicable to the categories (30% to 49%, 50% to 69%, 70% to 99%) used in ongoing symptomatic and asymptomatic carotid endarterectomy trials. This study was undertaken to determine new velocity criteria consistent with these categories. METHODS: From January 1, 1989 through October 30, 1992, 5871 color-flow duplex scans were obtained in our laboratories. After inadequate arteriograms and patients with a contralateral ICA occlusion were excluded, 770 peak systolic velocity (PSV) and 229 end-diastolic velocity (EDV) measurements were available for comparison with arteriography. ICA PSV and EDV were subjected to receiver operator characteristic curve analysis to determine optimum criteria for identifying stenoses of 30%, 50%, and 70%. RESULTS: For 70% to 99% carotid artery stenosis, PSV greater than 130 plus EDV greater than 100 provided the best sensitivity (81%), specificity (98%), positive predictive value (89%), negative predictive value (96%), and overall accuracy (95%). For 50% to 69% stenosis, a PSV greater than 130 and EDV of 100 or less cm/sec proved to be the best combination: sensitivity (92%), specificity (97%), positive predictive value (93%), negative predictive value (99%), and accuracy (97%). Stenoses in the 30% to 49% range were less accurately identified. CONCLUSION: These redefined criteria may prove useful for analyzing duplex ultrasound velocity data in reference to the classification of ICA stenosis used in recent clinical trials of the safety and efficacy of carotid endarterectomy.
Authors: Nicolle Cassola; Jose Cc Baptista-Silva; Luis Cu Nakano; Carolina Dq Flumignan; Ricardo Sesso; Vladimir Vasconcelos; Nelson Carvas Junior; Ronald Lg Flumignan Journal: Cochrane Database Syst Rev Date: 2022-07-11
Authors: Wael E Shaalan; Carl M Wahlgren; Tina Desai; Giancarlo Piano; Christopher Skelly; Hisham S Bassiouny Journal: J Vasc Surg Date: 2008-05-16 Impact factor: 4.268