What is the clinical evidence from this study?

Study design: Observational. Population: Internal carotid artery stenosis (n=143). Intervention: Duplex sonography (PSVICA/ICA ratio) vs. Computed tomography angiography (CTA). Primary outcome: Correlation between PSVICA/ICA ratio and CTA for evaluating carotid stenosis severity (r = 0.576, p=<0.001).

November 6, 2023Frontiers in Neurology7 citationsOpen Access

Peak systolic velocity ratio for evaluation of internal carotid artery stenosis correlated with plaque morphology: substudy results of the ANTIQUE study

Q: What are the key findings of this study?

The peak systolic velocity ratio (PSVICA/ICA) showed the highest correlation with computed tomography angiography for evaluating internal carotid artery stenosis severity (r = 0.576, p < 0.001).

DPDavid Pakizer AVAnna Vybíralová TJTomáš Jonszta

Key Result

The peak systolic velocity ratio (PSVICA/ICA) showed the highest correlation with computed tomography angiography for evaluating internal carotid artery stenosis severity (r = 0.576, p < 0.001).

Study Design

Type

Observational (n=143)

Multicenter

Yes

Structured PICO

Does the PSVICA/ICA ratio measured by duplex sonography improve correlation with CTA for evaluating internal carotid artery stenosis severity compared to other sonographic parameters?

Population

143 patients aged 30 to 90 years with internal carotid artery stenosis of 40% or greater, evaluated to compare duplex sonography measurements with computed tomography angiography.

Exposure

Duplex sonography (DUS) measurements including peak systolic velocity (PSV), PSVICA/ICA ratio, end-diastolic velocity (EDV), and B-mode.

Comparator

Computed tomography angiography (CTA).

Outcome

Correlation between duplex sonography measurements and computed tomography angiography for evaluating carotid stenosis severity.surrogate

The PSVICA/ICA ratio demonstrates the highest correlation with CTA for evaluating internal carotid artery stenosis across most plaque morphologies, supporting its inclusion in routine duplex sonography assessment.

Main Result

Effect estimate: r = 0.576

p-value: p=<0.001

Limitations

CTA was used as the gold standard, which may underestimate the percentage of stenosis compared to DSA or histology.
Plaque composition and surface were evaluated using MRI, CTA, and DUS instead of histopathological evaluation.
Only manual evaluations and visual measurements were made without digital image analysis.
Imaging of distal extracranial ICA and velocity measurements could be more difficult in high-grade stenosis and near occlusion.
Measurement of carotid stenosis with calcified plaques in B-mode could be influenced by artifacts.
Sample size calculation did not allow for validation of parameters for individual ranges of carotid stenosis.
CTA used as gold standard instead of DSA or histology, which may underestimate stenosis.
Plaque composition evaluated by imaging rather than histopathology.
Manual evaluations without digital image analysis.
Potential difficulty imaging distal extracranial ICA in high-grade stenosis.
B-mode measurement influenced by artifacts from calcified plaques.
Sample size not powered for individual subtypes of atherosclerotic plaques.

Abstract

Background Accurate assessment of carotid stenosis severity is important for proper patient management. The present study aimed to compare the evaluation of carotid stenosis severity using four duplex sonography (DUS) measurements, including peak systolic velocity (PSV), PSV ratio in stenosis and distal to stenosis (PSVICA/ICA ratio), end-diastolic velocity (EDV), and B-mode, with computed tomography angiography (CTA), and to evaluate the impact of plaque morphology on correlation between DUS and CTA. Methods Consecutive patients with carotid stenosis of ≥40% examined using DUS and CTA were included. Plaque morphology was also determined using magnetic resonance imaging. Spearman’s correlation and Kendall’s rank correlation were used to evaluate the results. Results A total of 143 cases of internal carotid artery stenosis of ≥40% based on DUS were analyzed. The PSVICA/ICA ratio showed the highest correlation [Spearman’s correlation r = 0.576) with CTA, followed by PSV (r = 0.526), B-mode measurement (r = 0.482), and EDV (r = 0.441; p 0.05 in all cases). Conclusion PSV, PSVICA/ICA ratio, EDV, and B-mode measurements showed comparable correlations with CTA in evaluation of carotid artery stenosis based on their correlation with CTA results. Heavy calcifications and plaque surface irregularity or ulceration negatively influenced the measurement accuracy.

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