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Redefined Duplex Ultrasonographic Criteria for Diagnosis of Carotid Artery Stenosis

      OBJECTIVE

      To evaluate duplex ultrasongraphic criteria for the determination of 50 % or more and 70% or more stenosis of the diameter of the internal carotid artery based on conventional angiography in order to align ultrasongraphic diagnostic categories with current clinical management schemes.

      PATIENTS AND METHODS

      Between January 1, 1995, and June 30,1999, 915 patients underwent both carotid duplex ultrasonography and cerebral angiography within 30 days at Mayo Clinic, Rochester, Minn. Of these patients, 294 were excluded from this study because of occlusion of one or both of the internal carotid arteries or atypical Dow characteristics. In the remaining 621 patients (61 % male, 39% female; mean age, 67.7 years [range, 14-88 years]), 1218 vessels were available for correlation. Several Doppler ultrasongraphic velocity variables were compared with the angiographic findings by use of receiver operating characteristic curve analysis. The primary end point was verification of optimal ultrasongraphic criteria to diagnose 70% or more internal carotid artery stenosis. The secondary end point was establishment of threshold values to detect stenosis of 500/0 or more.

      RESULTS

      At angiography, 382 patients had internal carotid arteries with 70% or more stenosis. Peak systolic and end diastolic velocities of the internal carotid artery and internal carotid artery:common carotid artery peak systolic velocity ratios were measured. For an internal carotid artery stenosis of 70% or more, a peak systolic velocity of 230 cm/s or more resulted in a sensitivity of 86.4%, a specificity of 90.1%, a positive predictive value of 82.7%, a negative predictive value of 92.3%, and an accuracy of 88.8% An end diastolic velocity of 70 cm/s or more and an internal carotid artery:common carotid artery ratio of 3.2 or more yielded similar values. For an internal carotid artery stenosis of 50% or more, a peak systolic velocity of 130 cm/s or more resulted in a sensitivity of 92.1%, a specificity of 89.50/0, a positive predictive value of 90.3%, a negative predictive value of 91.3%, and an overall accuracy of 90.8%. An internal carotid artery:common carotid artery ratio of 1.6 or more yielded similar values.

      CONCLUSION

      In our ultrasonography laboratory, a carotid artery stenosis of 70% or more (for which carotid endarterectomy is typically recommended in symptomatic patients) is diagnosed reliably with the following duplex ultrasongraphic criteria: a peak systolic velocity of 230 cms or more, an end diastolic velocity of 70 cm/s or more, or an internal carotid artery:common carotid artery ratio of 3.2 or more.
      CCA (common carotid artery), CT (computed tomographic), ECST (European Carotid Surgery Trial), EDV (end diastolic velocity), ICA (internal carotid artery), NASCET (North American Symptomatic Carotid Endarterectomy Trial), PSV (peak systolic velocity), VA (Veterans Affairs)
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