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Predictive ability of duplex ultrasonography for internal carotid artery stenosis of 70%-99%: a comparative study. 1998

J C Chen, and A J Salvian, and D C Taylor, and P A Teal, and T R Marotta, and Y N Hsiang
Department of Surgery, Vancouver Hospital and Health Sciences Centre, University of British Columbia, Canada.

This study prospectively compared the accuracy of published duplex ultrasonographic criteria for 70%-99% internal carotid artery (ICA) stenosis according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method to determine angiographic stenosis. From March 1, 1995 to December 1, 1995, all patients considered for carotid endarterectomy (CEA) were studied with carotid duplex ultrasound and carotid angiography within 1 month of the ultrasound study. Duplex measurements of ICA peak systolic velocity (PSV), end diastolic velocity (EDV), and ratio of the ICA to common carotid artery (CCA) PSVs were recorded. Degree of stenosis on angiography was determined using NASCET criteria. A MEDLINE search to identify duplex ultrasound criteria to predict NASCET defined 70%-99% ICA stenosis was carried out. In addition, the original University of Washington criteria for critical stenosis (> or = 80%) was also examined. The accuracy of these criteria was determined with angiographic results and the positive predictive value (PPV) of each criterion were compared. Ninety-nine patients with 185 carotid bifurcations were available for comparison. The different duplex criteria for determining NASCET defined 70%-99% ICA stenosis were: ICA PSV > 175 cm/sec or PSV < 40 cm/sec, PSV > 230 cm/sec, ratio of ICA to CCA PSVs > 4, PSV > 130 cm/sec plus EDV > 100 cm/sec, and PSV > 270 cm/sec plus EDV > 110 cm/sec. When compared with angiography, the calculated PPVs for these criteria were 71% (73/103), 81% (71/88), 86% (67/78), 88% (62/70), and 90% (57/63), respectively. The University of Washington criteria for critical stenosis (PSV > 125 cm/sec plus EDV > 135 cm/sec) had the highest PPV at 91.6% (55/60). The University of Washington criteria for critical stenosis had the highest PPV to predict a 70%-99% angiographic stenosis.

UI MeSH Term Description Entries
D001783 Blood Flow Velocity A value equal to the total volume flow divided by the cross-sectional area of the vascular bed. Blood Flow Velocities,Flow Velocities, Blood,Flow Velocity, Blood,Velocities, Blood Flow,Velocity, Blood Flow
D002343 Carotid Artery, Internal Branch of the common carotid artery which supplies the anterior part of the brain, the eye and its appendages, the forehead and nose. Arteries, Internal Carotid,Artery, Internal Carotid,Carotid Arteries, Internal,Internal Carotid Arteries,Internal Carotid Artery
D003971 Diastole Post-systolic relaxation of the HEART, especially the HEART VENTRICLES. Diastoles
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012680 Sensitivity and Specificity Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed) Specificity,Sensitivity,Specificity and Sensitivity
D013599 Systole Period of contraction of the HEART, especially of the HEART VENTRICLES. Systolic Time Interval,Interval, Systolic Time,Intervals, Systolic Time,Systoles,Systolic Time Intervals,Time Interval, Systolic,Time Intervals, Systolic
D016893 Carotid Stenosis Narrowing or stricture of any part of the CAROTID ARTERIES, most often due to atherosclerotic plaque formation. Ulcerations may form in atherosclerotic plaques and induce THROMBUS formation. Platelet or cholesterol emboli may arise from stenotic carotid lesions and induce a TRANSIENT ISCHEMIC ATTACK; CEREBROVASCULAR ACCIDENT; or temporary blindness (AMAUROSIS FUGAX). (From Adams et al., Principles of Neurology, 6th ed, pp 822-3) Carotid Artery Narrowing,Carotid Ulcer,Carotid Artery Plaque,Carotid Artery Stenosis,Carotid Artery Ulcerating Plaque,Common Carotid Artery Stenosis,External Carotid Artery Stenosis,Internal Carotid Artery Stenosis,Plaque, Ulcerating, Carotid Artery,Stenosis, Common Carotid Artery,Stenosis, External Carotid Artery,Ulcerating Plaque, Carotid Artery,Artery Narrowing, Carotid,Artery Narrowings, Carotid,Artery Plaque, Carotid,Artery Plaques, Carotid,Artery Stenoses, Carotid,Artery Stenosis, Carotid,Carotid Artery Narrowings,Carotid Artery Plaques,Carotid Artery Stenoses,Carotid Stenoses,Carotid Ulcers,Narrowing, Carotid Artery,Narrowings, Carotid Artery,Plaque, Carotid Artery,Plaques, Carotid Artery,Stenoses, Carotid,Stenoses, Carotid Artery,Stenosis, Carotid,Stenosis, Carotid Artery,Ulcer, Carotid,Ulcers, Carotid
D016894 Endarterectomy, Carotid The excision of the thickened, atheromatous tunica intima of a carotid artery. Carotid Endarterectomy,Carotid Endarterectomies,Endarterectomies, Carotid
D018616 Ultrasonography, Doppler, Duplex Ultrasonography applying the Doppler effect combined with real-time imaging. The real-time image is created by rapid movement of the ultrasound beam. A powerful advantage of this technique is the ability to estimate the velocity of flow from the Doppler shift frequency. Doppler Ultrasonography, Duplex,Ultrasonography, Duplex Doppler,Doppler Duplex Ultrasonography,Duplex Doppler Ultrasonography,Duplex Ultrasonography, Doppler,Ultrasonography, Doppler Duplex

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