(Stroke. 1996;27:695-699.)
© 1996 American Heart Association, Inc.
Articles |
Determination of Duplex Doppler Ultrasound Criteria Appropriate to the North American Symptomatic Carotid Endarterectomy Trial
From the Departments of Surgery (J.P.C., J.T.D.) and Radiology (F.J.L.), University of Pennsylvania School of Medicine, Philadelphia.
Background and Purpose The North American Symptomatic
Carotid Endarterectomy Trial (NASCET) demonstrated the benefit of
carotid endarterectomy for symptomatic
patients with 
70% carotid stenosis. Screening for detection
of significant carotid occlusive disease has relied on duplex
Doppler imaging. However, traditional duplex categories (50% to
79%, 80% to 99%) are not directly applicable to NASCET. We sought to
evaluate duplex criteria for determination of 70% carotid
stenosis.
Methods Duplex scans and arteriograms of 110 patients (210 carotids), performed within 1 month of each other, were reviewed by blinded readers. Arteriographic stenosis was determined by the NASCET method. Duplex measurements of peak systolic and end-diastolic velocity (PSV, EDV) were recorded, and ratios of velocities in the internal and common carotid arteries (ICA, CCA) were calculated. Receiver-operator characteristic (ROC) curves of sensitivity, specificity, positive and negative predictive values (PPV, NPV), and accuracy were determined.
Results Interobserver agreement for measurement of
arteriographic stenosis was "almost perfect" (
=0.86).
The criteria chosen for detection of 70% stenosis were
PSVICA >210 cm/s (sensitivity, 94%; specificity, 77%;
PPV, 68%; NPV, 96%; accuracy, 83%), EDVICA >70 cm/s
(sensitivity, 92%; specificity, 60%; PPV, 73%; NPV, 86%; accuracy
77%), PSVICA/PSVCCA >3.0 (sensitivity,
91%; specificity, 78%; PPV, 70%; NPV, 94%; accuracy, 83%), and
EDVICA/EDVCCA >3.3 (sensitivity, 100%;
specificity, 65%; PPV, 65%; NPV, 100%; accuracy, 79%).
Conclusions We conclude that 70% carotid
stenosis can be reliably determined by duplex
Doppler ultrasound. Individual vascular laboratories must validate
their own results.
Key Words: carotid endarterectomy • carotid stenosis • Doppler • ultrasonics
This article has been cited by other articles:
 |
|
 |
|
  C. Setacci, E. Chisci, F. Setacci, F. Iacoponi, and G. de Donato Grading Carotid Intrastent Restenosis: A 6-Year Follow-Up Study Stroke, April 1, 2008; 39(4): 1189 - 1196. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Bilora, E. Zanon, A. Casonato, A. Bertomoro, F. Petrobelli, M. Cavraro, E. Campagnolo, and A. Girolami Type IIB von Willebrand Disease: Role of Qualitative Defects in Atherosclerosis and Endothelial Dysfunction Clinical and Applied Thrombosis/Hemostasis, October 1, 2007; 13(4): 384 - 390. [Abstract] [PDF]
|
|
|
|
 |
|
 G. Schulte-Altedorneburg, F. J. Ahlhelm, E. S. Bartlett, S. P. Symons, and A. J. Fox Simplification of the residual lumen geometry in measuring carodid stenosis. AJNR Am. J. Neuroradiol., May 1, 2007; 28(5): 804 - 804. [Full Text] [PDF]
|
|
|
|
|
|
E. S. Bartlett, T. D. Walters, S. P. Symons, and A. J. Fox Carotid Stenosis Index Revisited With Direct CT Angiography Measurement of Carotid Arteries to Quantify Carotid Stenosis Stroke, February 1, 2007; 38(2): 286 - 291. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Allocca, A Crosignani, A Gritti, G Ghilardi, D Gobatti, D Caruso, M Zuin, M Podda, and P M Battezzati Hypercholesterolaemia is not associated with early atherosclerotic lesions in primary biliary cirrhosis Gut, December 1, 2006; 55(12): 1795 - 1800. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Bilora, E. Zanon, F. Petrobelli, M. Cavraro, P. Prandoni, A. Pagnan, and A. Girolami Does Hemophilia Protect Against Atherosclerosis? A Case-Control Study Clinical and Applied Thrombosis/Hemostasis, April 1, 2006; 12(2): 193 - 198. [Abstract] [PDF]
|
|
|
|
|
|
E.S. Bartlett, S.P. Symons, and A.J. Fox Correlation of Carotid Stenosis Diameter and Cross-Sectional Areas with CT Angiography AJNR Am. J. Neuroradiol., March 1, 2006; 27(3): 638 - 642. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E.S. Bartlett, T.D. Walters, S.P. Symons, and A.J. Fox Quantification of Carotid Stenosis on CT Angiography AJNR Am. J. Neuroradiol., January 1, 2006; 27(1): 13 - 19. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Wessels, J. U. Harrer, S. Stetter, M. Mull, and C. Klotzsch Three-Dimensional Assessment of Extracranial Doppler Sonography in Carotid Artery Stenosis Compared With Digital Subtraction Angiography Stroke, August 1, 2004; 35(8): 1847 - 1851. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. G. Grant, C. B. Benson, G. L. Moneta, A. V. Alexandrov, J. D. Baker, E. I. Bluth, B. A. Carroll, M. Eliasziw, J. Gocke, B. S. Hertzberg, et al. Carotid Artery Stenosis: Gray-Scale and Doppler US Diagnosis--Society of Radiologists in Ultrasound Consensus Conference Radiology, November 1, 2003; 229(2): 340 - 346. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Bucek, M. Reiter, A. Dirisamer, M. Haumer, A. Fritz, E. Minar, and J. Lammer Three-Dimensional Color Doppler Sonography in Carotid Artery Stenosis AJNR Am. J. Neuroradiol., August 1, 2003; 24(7): 1294 - 1299. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. A. Bucek, M. Reiter, I. Koppensteiner, R. Ahmadi, E. Minar, and J. Lammer B-Flow Evaluation of Carotid Arterial Stenosis: Initial Experience Radiology, October 1, 2002; 225(1): 295 - 299. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Logason, S. Karacagil, A. Tulga Ulus, and H.-G. Hardemark The Impact of Different Spectral Doppler Criteria on the Proportion of High-Grade Internal Carotid Artery Stenosis in Patients Undergoing Duplex Scanning Angiology, May 1, 2002; 53(3): 297 - 301. [Abstract] [PDF]
|
|
|
|
 |
|
 G. Melissano, R. Castellano, R. Zucca, and R. Chiesa Results of Carotid Endarterectomy Performed with Preoperative Duplex Ultrasound Assessment Alone Vascular and Endovascular Surgery, March 1, 2001; 35(2): 95 - 101. [Abstract] [PDF]
|
|
|
|
 |
|
 J. M. Serfaty, P. Chirossel, J. M. Chevallier, R. Ecochard, J. C. Froment, and P. C. Douek Accuracy of Three-Dimensional Gadolinium-Enhanced MR Angiography in the Assessment of Extracranial Carotid Artery Disease Am. J. Roentgenol., August 1, 2000; 175(2): 455 - 463. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. S. Lee, B. S. Hertzberg, M. J. Workman, T. P. Smith, M. A. Kliewer, D. M. DeLong, and B. A. Carroll Variability of Doppler US Measurements along the Common Carotid Artery: Effects on Estimates of Internal Carotid Arterial Stenosis in Patients with Angiographically Proved Disease Radiology, February 1, 2000; 214(2): 387 - 392. [Abstract] [Full Text]
|
|
|
|
|
|
E. G. Grant, A. J. Duerinckx, S. M. El Saden, M. L. Melany, G. M. Hathout, P. T. Zimmerman, A. K. Marumoto, S. N. Cohen, and J. D. Baker Ability to Use Duplex US to Quantify Internal Carotid Arterial Stenoses: Fact or Fiction?1 Radiology, January 1, 2000; 214(1): 247 - 252. [Abstract] [Full Text]
|
|
|
|
|
|
D. W. Droste, R. Jurgens, D. G. Nabavi, G. Schuierer, S. Weber, and E. B. Ringelstein Echocontrast-Enhanced Ultrasound of Extracranial Internal Carotid Artery High-Grade Stenosis and Occlusion Stroke, November 1, 1999; 30(11): 2302 - 2306. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. W Droste, R. Dittrich, V. Kemeny, G. Schulte-Altedorneburg, and E B. Ringelstein Prevalence and frequency of microembolic signals in 105 patients with extracranial carotid artery occlusive disease J. Neurol. Neurosurg. Psychiatry, October 1, 1999; 67(4): 525 - 528. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Ranke, A. Creutzig, H. Becker, and H.-J. Trappe Standardization of Carotid Ultrasound : A Hemodynamic Method to Normalize for Interindividual and Interequipment Variability Stroke, February 1, 1999; 30(2): 402 - 406. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. E. H. Elgersma, M. van Leersum, P. C. Buijs, M. S. van Leeuwen, Y. T. van de Schouw, B. C. Eikelboom, and Y. van der Graaf Changes Over Time in Optimal Duplex Threshold for the Identification of Patients Eligible for Carotid Endarterectomy Stroke, November 1, 1998; 29(11): 2352 - 2356. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Corti, C. Ferrari, M. Roberti, M. Alerci, P. L. Pedrazzi, and A. Gallino Spiral Computed Tomography : A Novel Diagnostic Approach for Investigation of the Extracranial Cerebral Arteries and Its Complementary Role in Duplex Ultrasonography Circulation, September 8, 1998; 98(10): 984 - 989. [Abstract] [Full Text]
|
|
|
|
|
|
C. Palombo, M. Kozakova, C. Morizzo, F. Andreuccetti, A. Tondini, P. Palchetti, G. Mirra, G. Parenti, and N. G. Pandian Ultrafast Three-Dimensional Ultrasound : Application to Carotid Artery Imaging Stroke, August 1, 1998; 29(8): 1631 - 1637. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. J. Dippel, F. van Kooten, S. L. M. Bakker, and P. J. Koudstaal Interobserver Agreement for 10% Categories of Angiographic Carotid Stenosis Stroke, December 1, 1997; 28(12): 2483 - 2485. [Abstract] [Full Text]
|
|
|
|
|
|
N. Suwanwela, U. Can, K. L. Furie, J. F. Southern, N. R. Macdonald, C. S. Ogilvy, C. J. Hansen, F. S. Buonanno, W. M. Abbott, W. J. Koroshetz, et al. Carotid Doppler Ultrasound Criteria for Internal Carotid Artery Stenosis Based on Residual Lumen Diameter Calculated From En Bloc Carotid Endarterectomy Specimens Stroke, November 1, 1996; 27(11): 1965 - 1969. [Abstract] [Full Text]
|
|