Determination of duplex Doppler ultrasound criteria appropriate to the North American Symptomatic Carotid Endarterectomy Trial

TY - JOUR

T1 - Determination of duplex Doppler ultrasound criteria appropriate to the North American Symptomatic Carotid Endarterectomy Trial

AU - Carpenter, J. P.

AU - Lexa, F. J.

AU - Davis, J. T.

PY - 1996

Y1 - 1996

N2 - 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' (κ=0.86). The criteria chosen for detection of ≥70% stenosis were PSV(ICA) >210 cm/s (sensitivity, 94%; specificity, 77%; PPV, 68%; NPV, 96%; accuracy, 83%), EDV(ICA) >70 cm/s (sensitivity, 92%; specificity, 60%; PPV, 73%; NPV, 86%; accuracy 77%), PSV(ICA)/PSV(CCA) >3.0 (sensitivity, 91%; specificity, 78%; PPV, 70%; NPV, 94%; accuracy, 83%), and EDV(ICA)/EDV(CCA) >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.

AB - 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' (κ=0.86). The criteria chosen for detection of ≥70% stenosis were PSV(ICA) >210 cm/s (sensitivity, 94%; specificity, 77%; PPV, 68%; NPV, 96%; accuracy, 83%), EDV(ICA) >70 cm/s (sensitivity, 92%; specificity, 60%; PPV, 73%; NPV, 86%; accuracy 77%), PSV(ICA)/PSV(CCA) >3.0 (sensitivity, 91%; specificity, 78%; PPV, 70%; NPV, 94%; accuracy, 83%), and EDV(ICA)/EDV(CCA) >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.

UR - https://www.scopus.com/pages/publications/0029915576

UR - https://www.scopus.com/pages/publications/0029915576#tab=citedBy

U2 - 10.1161/01.STR.27.4.695

DO - 10.1161/01.STR.27.4.695

M3 - Article

C2 - 8614933

SN - 0039-2499

VL - 27

SP - 695

EP - 699

JO - Stroke

JF - Stroke

IS - 4

ER -