(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
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