scholarly journals Optimization of duplex velocity criteria for diagnosis of internal carotid artery (ICA) stenosis: A report of the Intersocietal Accreditation Commission (IAC) Vascular Testing Division Carotid Diagnostic Criteria Committee

2021 ◽  
pp. 1358863X2110112
Author(s):  
Heather L Gornik ◽  
Tatjana Rundek ◽  
Hannah Gardener ◽  
James F Benenati ◽  
Nirvikar Dahiya ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Diagnostic Criteria ◽  
Internal Carotid ◽  
Peak Systolic Velocity ◽  
Duplex Ultrasound ◽  
Additional Parameter ◽  
Characteristic Analysis ◽  
Carotid Duplex ◽  
Ica Stenosis

Diagnostic criteria to classify severity of internal carotid artery (ICA) stenosis vary across vascular laboratories. Consensus-based criteria, proposed by the Society of Radiologists in Ultrasound in 2003 (SRUCC), have been broadly implemented but have not been adequately validated. We conducted a multicentered, retrospective correlative imaging study of duplex ultrasound versus catheter angiography for evaluation of severity of ICA stenosis. Velocity data were abstracted from bilateral duplex studies performed between 1/1/2009 and 12/31/2015 and studies were interpreted using SRUCC. Percentage ICA stenosis was determined using North American Symptomatic Carotid Endarterectomy Trial (NASCET) methodology. Receiver operating characteristic analysis evaluated the performance of SRUCC parameters compared with angiography. Of 448 ICA sides (from 224 patients), 299 ICA sides (from 167 patients) were included. Agreement between duplex ultrasound and angiography was moderate (κ = 0.42), with overestimation of degree of stenosis for both moderate (50–69%) and severe (⩾ 70%) ICA lesions. The primary SRUCC parameter for ⩾ 50% ICA stenosis of peak-systolic velocity (PSV) of ⩾ 125 cm/sec did not meet prespecified thresholds for adequate sensitivity, specificity, and accuracy (sensitivity 97.8%, specificity 64.2%, accuracy 74.5%). Test performance was improved by raising the PSV threshold to ⩾ 180 cm/sec (sensitivity 93.3%, specificity 81.6%, accuracy 85.2%) or by adding the additional parameter of ICA/common carotid artery (CCA) PSV ratio ⩾ 2.0 (sensitivity 94.3%, specificity 84.3%, accuracy 87.4%). For ⩾ 70% ICA stenosis, analysis was limited by a low number of cases with angiographically severe disease. Interpretation of carotid duplex examinations using SRUCC resulted in significant overestimation of severity of ICA stenosis when compared with angiography; raising the PSV threshold for ⩾ 50% ICA stenosis to ⩾ 180 cm/sec as a single parameter or requiring the ICA/CCA PSV ratio ⩾ 2.0 in addition to PSV of ⩾ 125 cm/sec for laboratories using the SRUCC is recommended to improve the accuracy of carotid duplex examinations.

scholarly journals Ocular Image and Haemodynamic Features Associated with Different Gradings of Ipsilateral Internal Carotid Artery Stenosis

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Hui Wang ◽  
Hongyang Li ◽  
Xiaojie Zhang ◽  
Lanyan Qiu ◽  
Zhenchang Wang ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Layer Thickness ◽  
Internal Carotid ◽  
Peak Systolic Velocity ◽  
Central Retinal Artery ◽  
Chinese Patients ◽  
Retinal Layer ◽  
Retinal Artery ◽  
Ica Stenosis

Objectives. To analyse the changes of ocular haemodynamics and morphology in Chinese patients with internal carotid artery (ICA) stenosis in the current study. Methods. A retrospective case-control study was conducted with 219 patients. The haemodynamic characteristics, the calibre of retinal vessels, and the subfoveal choroidal thickness (SFChT) were compared. We analysed the correlations with the degree of ipsilateral ICA stenosis. Results. There were no significant differences among the groups in the central retinal artery equivalent (CRAE), central retinal vein equivalent (CRVE), and AVR (p=0.073, p=0.188, and p=0.738, resp.). The peak systolic velocity (PSV) and end diastolic velocity (EDV) in the central retinal artery (CRA) and the posterior ciliary artery (PCA) were significantly lower than normal eyes (p<0.001). The outer retinal layer thickness and SFChT values of the ICA stenosis groups were significantly lower than normal eyes (p=0.030 and p<0.001, resp.). Conclusion. The PSV and EDV in CRA and PCA and the SFChT and outer retinal layer thickness of ICA eyes were significantly lower than normal eyes. ICA stenosis may impact choroidal haemodynamics, and decreased choroidal circulation might affect the discordance of the SFChT and the outer retinal layer thickness.

Variability of Doppler Velocity Ratios as a Function of Location in the Common Carotid Artery: Potential Problems When Quantifying Significant Internal Carotid Artery Stenoses

2003 ◽  
Vol 27 (1) ◽  
pp. 16-19 ◽  
Author(s):  
Robert P. Scissons ◽  
Joseph C. Gillis ◽  
Robert B. Patterson ◽  
Albert K. Weyman
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Internal Carotid ◽  
Velocity Ratio ◽  
Sampling Site ◽  
Peak Systolic Velocity ◽  
Absolute Difference ◽  
Doppler Velocity ◽  
Ica Stenosis

Introduction The use of the internal carotid artery (ICA) to common carotid artery (CCA) peak systolic velocity ratio (ICApsv/CCApsv) to quantitate ICA stenosis has been challenged based on the variability of Doppler-derived velocities at various locations within the CCA. We investigated these alleged differences to determine whether they affect actual classification of significant ICA stenoses. Methods Data from consecutive patients for an 18-month period were prospectively entered into a database. Only initial studies were included in this investigation. Follow-up examinations, postendarterectomy vessels, ICA occlusions, and CCA vessels with a PSV of >150 cm/sec were excluded from analysis. CCApsvand ICApsv/CCApsvwere obtained and based on Doppler analysis at both the proximal most visualized CCA segment (proximal), and 1.5 cm proximal to the ICA flow divider (distal). ICApsv/CCApsv values of ≥ 2, ≥ 3, and ≥ 4 were used as threshold values for ≥ 50%, ≥ 60%, and ≥ 70% diameter stenoses. Results A total of 383 patients and 588 vessels were analyzed. CCApsv -proximal values, 75 ± 20 cm/sec, were significantly higher than CCApsv -distal, 68 ± 16 cm/sec (p < 0.001). ICApsv/ CCApsv -distal ratios, 2.36 ± 2.77, were significantly higher than ICApsv/ CCApsv -proximal, 2.11 ± 2.46, (p < 0.001). The average absolute difference between CCApsv -proximal and CCApsv -distal was 15% ± 13% (range, 0%–93%). For an ICApsv/CCApsv ≥ 50%, proximal and distal ratios would both be < 2 in 66%, ≥ 2 in 29%, and 5% were contradictory. For an ICApsv/CCApsv ≥ 60%, proximal and distal ratios would both be < 3 in 78%, ≥ 3 in 18%, and 4% contradictory. For an ICApsv/CCApsv ≥ 70%, proximal and distal ratios would both be < 4 in 85%, ≥ 4 in 12%, and in 3% contradictory. Conclusions Significant differences in ICApsv/CCApsv calculation as a function of location of the CCApsv measurement were confirmed. Proximal and distal sampling sites, however, did not affect ICApsv/CCApsv classifications for 95% of the vessels analyzed. For contradictory classifications, ICApsv/CCApsv -distal had more potential for a positive result. To improve accuracy and address sensitivity or specificity interpretation parameters, the influence of the CCA sampling site should be considered and standardized when using carotid ratio criteria.

scholarly journals Suitable methods of measuring acceleration time in the diagnosis of internal carotid artery stenosis

2020 ◽  
Vol 47 (2) ◽  
pp. 327-333
Author(s):  
Kentaro Iizuka ◽  
Hidehiro Takekawa ◽  
Akio Iwasaki ◽  
Haruki Igarashi ◽  
Keisuke Suzuki ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Peak Systolic Velocity ◽  
Internal Carotid Artery Stenosis ◽  
Acceleration Time ◽  
Symptomatic Carotid ◽  
Conventional Procedure ◽  
Stenosis Rate ◽  
Ica Stenosis

Abstract Purpose To enhance the utility of acceleration time (AcT) in the diagnosis of internal carotid artery (ICA) stenosis, we assessed the value of AcT measurements with different waveform patterns. Methods Ninety-three patients with acute atherothrombotic cerebral infarction were enrolled, and they underwent both carotid ultrasonography and digital subtraction angiography (DSA). AcT was determined by a conventional procedure (using the first peak point or the bending point) and the peak systolic velocity (PSV) procedure. The AcT ratio was calculated as (AcT of ICA)/(AcT of the ipsilateral common carotid artery). We evaluated the correlation of stenosis rate as assessed by the North American Symptomatic Carotid Endarterectomy Trial method using DSA (DSA-NASCET) with the AcT of ICA (ICA-AcT), the AcT ratio measured by the conventional procedure (conventional AcT ratio), and the AcT ratio measured by the PSV procedure (PSV AcT ratio). The area under receiver operating characteristic curves (AUC) for DSA-NASCET was calculated based on the ICA-AcT and AcT ratio. Results Forty-five vessels had 50% or greater ICA stenosis. DSA-NASCET was positively correlated with the conventional AcT ratio (r = 0.723), conventional ICA-AcT (r = 0.638), and PSV AcT ratio (r = 0.245). The corresponding AUCs for ICA stenosis ≥ 50% were 0.971, 0.886, and 0.572, respectively. Conclusion We demonstrated the usefulness of the conventional procedure for diagnosing stenosis of ICA origin using AcT and showed that the AcT ratio was a more beneficial parameter than AcT.

Do Common Carotid Artery Velocities Consistently Decrease With Proximity to the Bifurcation?

2019 ◽  
Vol 43 (4) ◽  
pp. 186-188
Author(s):  
Jean M. Alessi-Chinetti ◽  
Julio Perez ◽  
Mark D. Iafrati ◽  
Joseph F. Polak
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Common Carotid Artery ◽  
Carotid Arteries ◽  
Internal Carotid ◽  
Velocity Ratio ◽  
Peak Systolic Velocity ◽  
Stenosis Severity ◽  
The Difference ◽  
Ica Stenosis

Distal (near bifurcation) common carotid artery (CCA) peak systolic velocity (PSV) values are lower than near the origin (proximal). We investigate whether this applies to patients with internal carotid artery (ICA) stenosis ≥ 50% (PSV ≥ 125 cm/s). We studied 328 patients. We excluded carotid arteries with CCA stenosis and carotid endarterectomy. We evaluated degree of stenosis as absent, mild (1%-15%), moderate (16%-49%), and significant (≥50%; PSV ≥ 125 cm/s). We used paired t tests to compare the proximal with distal PSV values as a function of stenosis severity and analysis of variance for between stenosis differences. We studied 640 out of 656 bifurcations. Mean age was 68.9 (SD = 11.8) years, and 70% (228) men. Mean distal CCA PSV was 80.3 cm/s (SD = 23.1 cm/s) and proximal, 93.7 cm/s (SD = 26.6 cm/s). The difference between proximal and distal CCA PSV for ICA lesions < 50% (n = 553; 14.8 ± 22.6 cm/s) was higher ( P = .004) than with an ICA stenosis ≥ 50% (n = 87; 4.6 ± 24.1 cm/s). While distal CCA PSV decreases in patients with absent/mild/moderate plaque, PSV velocities are more consistent along the length of the CCA with higher degrees of ICA stenosis. This might in part explain the reliability of the ICA/CCA velocity ratio for grading stenosis severity ≥50%.

Hybrid Repair of a Common Carotid Pseudoaneurysm and Concomitant Internal Carotid Stenosis With Retrograde Stenting and Carotid Endarterectomy

2021 ◽  
pp. 153857442199293
Author(s):  
Constantinos Zarmakoupis ◽  
George Galyfos ◽  
Grigorios Tsoukalos ◽  
Panagiota Dalla ◽  
Alexandra Triantafyllou ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Common Carotid Artery ◽  
Rare Case ◽  
Internal Carotid ◽  
Covered Stent ◽  
Hybrid Technique ◽  
Hybrid Repair ◽  
Ica Stenosis

This report aims to present a rare case of a common carotid artery (CCA) pseudoaneurysm with a concomitant internal carotid artery (ICA) stenosis that were treated with a hybrid technique. This strategy included the retrograde placement of a CCA covered stent under ICA clamping followed by standardized carotid endarterectomy. The technique will be discussed and compared with other possible treatments.

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