Key result
Duplex ultrasound PSV threshold of 200 cm/s identifies severe carotid stenosis with ~90% sensitivity.
Why the study?
Carotid revascularization success depends on accurate stenosis grading, requiring vascular centers to establish specific protocols to determine PSV thresholds that predict moderate and severe internal carotid artery stenoses.
Does peak systolic velocity measured by ultrasound accurately predict the severity of internal carotid artery stenosis compared to digital subtraction angiography?
Cross-Sectional (n=35)
No
Does peak systolic velocity measured by ultrasound accurately predict the severity of internal carotid artery stenosis compared to digital subtraction angiography?
Answers are grounded in this paper and cite their sources.
Peak systolic velocity is a highly accurate marker for identifying severe internal carotid artery stenoses (NASCET ≥70% or ECST ≥80%), but is not reliable for moderate (≥50%) NASCET stenoses, highlighting the need for center-specific validation of ultrasound criteria.
(1) Background: The success of carotid revascularization depends on the accurate grading of carotid stenoses. Therefore, it is important for every vascular center to establish its protocols for the same. In this study, we aimed to determine the peak systolic velocity (PSV) thresholds that can predict moderate and severe internal carotid artery (ICA) stenoses. (2) Methods: To achieve this, we enrolled patients who underwent both duplex ultrasound (DUS) and invasive carotid artery digital subtraction angiography (DSA). The degree of ICA stenosis was assessed using the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) protocols. The PSV thresholds were determined using receiver operating characteristic (ROC) curves. (3) Results: Our study included 47 stenoses, and we found that the PSV cut-off for predicting ≥70% NASCET ICA stenoses was 200 cm/s (sensitivity 90.32%, specificity 93.75%). However, PSV did not correlate significantly with ≥50% NASCET ICA stenoses. On the other hand, the optimal PSV threshold for predicting ≥80% ECST ICA stenoses was 180 cm/s (sensitivity 100%, specificity 81.82%). (4) Conclusions: Based on our findings, we concluded that PSV is a good and simple marker for the identification of severe stenoses. We found that PSV values correlate significantly with severe NASCET and ECST stenoses, with 200 cm/s and 180 cm/s PSV thresholds. However, PSV was not reliable with moderate NASCET stenoses. In such cases, complementary imaging should be used.
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Tătaru et al. (2024) conducted a cross-sectional in Internal Carotid Artery Stenosis (n=35). Duplex ultrasound peak systolic velocity (PSV) measurement vs. Invasive digital subtraction angiography (DSA) was evaluated on Diagnostic accuracy (AUC) of PSV for predicting severe (≥70%) NASCET ICA stenosis (AUC 0.972, 95% CI 0.876-0.998, p=<0.0001). A peak systolic velocity threshold of 200 cm/s via duplex ultrasound accurately identified ≥70% NASCET internal carotid artery stenoses with 90.32% sensitivity and 93.75% specificity.
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