Jesus M. Matos1, Sally Mccoy2, George T. Pisimisis1, Deborah Felkai2, Neal R. Barshes1, Peter H. Lin1, Panos Kougias1, Carlos F. Bechara1
1Baylor College of Medicine, Houston, TX; 2Michael E.DeBakey VA medical center, Houston, TX.
OBJECTIVES: No consensus exists for duplex ultrasound criteria in diagnosing significant common carotid artery (CCA) stenosis. In general, peak systolic velocity (PSV) >150cm/s with post-stenotic turbulence indicates a stenosis >50%. The purpose of our study is to correlate CCA duplex velocities with angiographic findings of significant CCA stenosis >60%.
METHODS: We reviewed the carotid duplex records from 2008-2011 looking for patients with isolated CCA stenosis and no ipsilateral internal or contralateral carotid artery disease who either received a carotid angiogram (CA) or a computed tomographic angiography (CTA). We identified 25 patients who had CCA stenosis > 60%. We also randomly selected 74 controls with no known CCA stenosis. We performed receiver operating characteristics (ROC) analysis to correlate PSV and end-diastolic velocity (EDV) with angiographic stenosis >60%. The degree of stenosis was determined by measuring the luminal stenosis in comparison to the proximal normal CCA diameter just below the lesion.
RESULTS: Most patients had a carotid angiogram (17/25), 4 had a CTA only and 4 had both. Eighteen patients had history of a radiated neck. Eighteen patients were treated with a stent, 3 with endarterectomy and 4 with medical management. The CCA PSV>250cm/sec had a sensitivity of 100% (81.5-100%) and a specificity of 98.7% (92.0-99.9%), The CCA EDV>60cm/sec had a sensitivity of 95.5% (75.1-99.8%) and specificity of 100% (94.1-100%). The presence of both PSV<250 and EDV<60 cm/sec had a 100% negative predictive value, and the presence of both PSV≥250 and EDV≥60 had 100% positive predictive value.
CONCLUSIONS: Establishing CCA duplex criteria to screen patients with significant stenosis is crucial to identify those that will need further imaging modality or treatment. In our lab, CCA PSV>250cm/sec and EDV>60cm/sec are thresholds that can be used to identify significant (>60%) CCA stenosis with a high degree of accuracy.
AUTHOR DISCLOSURES: N. R. Barshes: Nothing to disclose; C. F. Bechara: Nothing to disclose; D. Felkai: Nothing to disclose; P. Kougias: Nothing to disclose; P. H. Lin: Nothing to disclose; J. M. Matos: Nothing to disclose; S. Mccoy: Nothing to disclose; G. T. Pisimisis: Nothing to disclose.
Posted April 2013