Authors: Scissons R.P.; Gillis J.C.; Patterson R.B.; Weyman A.K.

Source: Journal for Vascular Ultrasound, Volume 27, Number 1, 1 March 2003 , pp. 16-19(4)

Publisher: Society for Vascular Ultrasound

Abstract:

Introduction.—The use of the internal carotid artery (ICA) to common carotid artery (CCA) peak systolic velocity ratio (ICA^psv/CCA^psv) 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. CCA^psv and ICA^psv/CCA^psv were 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). ICA^psv/CCA^psv 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. CCA^psv-proximal values, 75 ± 20 cm/sec, were significantly higher than CCA^psv-distal, 68 ± 16 cm/sec (p < 0.001). ICApsv/ CCA^psv-distal ratios, 2.36 ± 2.77, were significantly higher than ICA^psv/CCA^psv-proximal, 2.11 ± 2.46, (p < 0.001). The average absolute difference between CCA^psv-proximal and CCA^psv-distal was 15% ± 13% (range, 0%–93%). For an ICA^psv/CCA^psv 50%, proximal and distal ratios would both be < 2 in 66%, 2 in 29%, and 5% were contradictory. For an ICA^psv/CCA^psv 60%, proximal and distal ratios would both be < 3 in 78%, 3 in 18%, and 4% contradictory. For an ICA^psv/CCA^psv 70%, proximal and distal ratios would both be < 4 in 85%, 4 in 12%, and in 3% contradictory.

Conclusions.—Significant differences in ICA^psv/CCA^psv calculation as a function of location of the CCA^psv measurement were confirmed. Proximal and distal sampling sites, however, did not affect ICA^psv/CCA^psv classifications for 95% of the vessels analyzed. For contradictory classifications, ICA^psv/CCA^psv-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.

Document Type: Research article

Publication date: 2003-03-01

More about this publication?

• The Journal for Vascular Ultrasound (JVU) is the official journal of the Society for Vascular Ultrasound. It consists of original scientific and educational articles, case studies, book reviews, technical reviews, ultrasound principle reviews, viewpoints, letters to the editor, and CME tests. Regular reading of JVU, published quarterly, will keep you current in your field and provide essential information that can be applied in your practice.
  
  Previously known as the Journal of Vascular Technology - View Volumes 16-26 here
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