Key result
Ultrasound PSV ≥200 cm/s detects significant ECA stenosis with ~91% accuracy versus CTA.
Why the study?
Does a specific peak systolic velocity cutoff on carotid ultrasound accurately detect 50% to 99% external carotid artery stenosis compared to CTA?
Observational (n=536)
Does a specific peak systolic velocity cutoff on carotid ultrasound accurately detect 50% to 99% external carotid artery stenosis compared to CTA?
A peak systolic velocity cutoff of ⩾200 cm/s on carotid ultrasound provides high diagnostic accuracy for detecting 50% to 99% external carotid artery stenosis.
May support initial ECA stenosis criteria in vascular labs; leaves open prospective validation before routine adoption.
External carotid artery (ECA) disease has been understated in the current literature, likely secondary to the lack of clinical neurological symptoms when this vessel is stenotic. However, vascular ultrasound credentialing entities request the adoption of specific criteria for the assessment of the ECA. Our purpose is to determine the ultrasound criteria for the detection of hemodynamically significant stenosis (50%-99%) using computed tomography angiography (CTA) as the reference standard. We included patients who had a carotid ultrasound and a CTA of the neck performed both within a 12-month period. Ultrasound measurements were reviewed for technical accuracy. CTAs were reassessed to determine the degree of stenosis of the bilateral ECAs adopting the North American Symptomatic Carotid Endarterectomy Trial criteria. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different peak systolic velocity (PSV) cutoff points to determine the most accurate PSV for detecting 50% to 99% stenosis of the ECA. Receiver operating curve analysis was used to assess diagnostic performance. Of the 536 ECAs included in this study, 13 were noted to be occluded by CTA. Six of these occlusions were accurately detected by ultrasound. There were 82 ECAs with 50% to 99% stenosis on CTA; these vessels had a significantly higher mean PSV compared to ECAs with <50% stenosis (294 vs 122 cm/s) ( P < .0001). A cutoff velocity of ⩾200 cm/s demonstrated a sensitivity, specificity, and overall accuracy of 0.84, 0.93, and 0.91, respectively. Using univariate analysis, smoking was significantly associated with the presence of ⩾50% ECA stenosis. We determined that a PSV cutoff of ⩾200 cm/s showed high sensitivity and specificity for detecting 50% to 99% ECA stenosis based on CTA.
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Xu et al. (2018) conducted an observational in External carotid artery stenosis (n=536). Carotid ultrasound peak systolic velocity vs. Computed tomography angiography (CTA) was evaluated on Detection of 50% to 99% external carotid artery stenosis. A peak systolic velocity cutoff of ⩾200 cm/s on ultrasound demonstrated a sensitivity of 0.84, specificity of 0.93, and accuracy of 0.91 for detecting 50% to 99% ECA stenosis compared to CTA.
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