Skip to main content
SpringerLink
Log in

Carotid Duplex Consensus Criteria on Interpretation of Carotid Duplex Ultrasound

  • Reference work entry
  • First Online:
Noninvasive Vascular Diagnosis

Abstract

Clinicians have relied on published institutional experience for interpreting carotid duplex ultrasound exams. This study analyzed 376 carotid arteries to validate the ultrasound imaging consensus criteria published in 2003. Receiver operating curves (ROC) were used to compare peak systolic velocities (PSV), end-diastolic velocities (EDV) of the internal carotid artery (ICA), and ICA/common carotid ratios in detecting <50%, 50–69% (ICA PSV of 125–230 cm/s), and 70–99% (PSV of ≥230 cm/s) stenosis according to the consensus criteria. The consensus criteria uses a PSV of 125–230 cm/s for detecting angiographic stenosis of 50–69%, which had a sensitivity of 93%, specificity of 68%, and overall accuracy of 85%. A PSV of ≥230 cm/s for ≥70% stenosis had a sensitivity of 99%, specificity of 86%, and overall accuracy of 95%. ROC curves showed that the ICA PSV was significantly better than EDV or ICA/CCA ratio (p = 0.036) in detecting ≥70% stenosis and ≥50% stenosis. The consensus criteria for diagnosing 50–69% stenosis can be significantly improved by using an ICA PSV of 140–230 cm/s, with a sensitivity of 94%, a specificity of 92%, and an overall accuracy of 92%.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  1. AbuRahma AF, Robinson PA, Stickler DL, Alberts S, Young L. Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials. Ann Vasc Surg. 1998;12:349–58.

    Article  CAS  Google Scholar 

  2. Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katarick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler E. Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis – Society of Radiologists in Ultrasound consensus conference. Ultrasound Q. 2003;19:190–8.

    Article  Google Scholar 

  3. Ricotta JJ, AbuRahma AF, Ascher E, Eskandari M, Faries P, Lal BK. Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease. J Vasc Surg. 2011;54:e1–e31.

    Article  Google Scholar 

  4. Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease. Circulation. 2011;124:e54–e130.

    Article  Google Scholar 

  5. Naylor A, Adair W. Cerebrovascular diseases. In: Sidawy AN, Perler B, editors. Rutherford’s textbook of vascular surgery and endovascular therapy. 9th ed. Philadelphia: Elsevier; 2018. p. 1149–65.

    Google Scholar 

  6. Wardlaw JM, Chappell FM, Stevenson M, De Nigris E, Thomas S, Gillard J, et al. Accurate, practical and cost-effective assessment of carotid stenosis in the UK. Health Technol Assess. 2006;10(30):iii–iv, ix–x, 1–182.

    Google Scholar 

  7. Loftus IM, McCarthy JM, Pau H, Hartshorne T, Bell PR, London NJ, et al. Carotid endarterectomy without angiography does not compromise operative outcome. Eur J Vasc Endovasc Surg. 1998;16(6):489–93.

    Article  CAS  Google Scholar 

  8. Huston J III, James EM, Brown RD Jr, et al. Redefined duplex ultrasonographic criteria for diagnosis of carotid artery stenosis. Mayo Clin Proc. 2000;75:1133–40.

    Article  Google Scholar 

  9. Braun RM, Bertino RE, Milbrandt J, Bray M. Ultrasound imaging of carotid artery stenosis: application of the Society of Radiologists in ultrasound consensus criteria to a single institution clinical practice. Ultrasound Q. 2008;24:161–6.

    Article  Google Scholar 

  10. Grant EG, Duerincks AJ, Saden S, et al. Doppler sonographic parameters for detection of carotid stenosis: is there an optimum method for their selection? Am J Roentgenol. 1999;172:1123–9.

    Article  CAS  Google Scholar 

  11. Carpenter JP, Lexa FJ, Davis JT. Determination of duplex Doppler ultrasound criteria appropriate to the North American symptomatic carotid endarterectomy trial. Stroke. 1996;27:695–9.

    Article  CAS  Google Scholar 

  12. Hood DB, Mattos MA, Mansour A, et al. Prospective evaluation of new duplex criteria to identify 70% internal carotid artery stenosis. J Vasc Surg. 1996;23:254–61.

    Article  CAS  Google Scholar 

  13. Carpenter JP, Lexa FJ, Davis JT. Determination of sixty percent or greater carotid artery stenosis by duplex Doppler ultrasonography. J Vasc Surg. 1995;22:697–703.

    Article  CAS  Google Scholar 

  14. Moneta GL, Edwards JM, Papanicolaou G, et al. Screening for asymptomatic internal carotid artery stenosis: duplex criteria for discriminating 60% to 99% stenosis. J Vasc Surg. 1995;21:989–94.

    Article  CAS  Google Scholar 

  15. Neale ML, Chambers JL, Kelly AT, et al. Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American symptomatic carotid endarterectomy trial and the European carotid surgery trial. J Vasc Surg. 1994;20:642–9.

    Article  CAS  Google Scholar 

  16. Moneta GL, Edwards JM, Chitwood RW, et al. Correlation of North American symptomatic carotid endarterectomy trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning. J Vasc Surg. 1993;17:152–9.

    Article  CAS  Google Scholar 

  17. Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis – Society of Radiologists in Ultrasound consensus conference. Radiology. 2003;229:340–6.

    Article  Google Scholar 

  18. Armstrong PA, Bandyk DF, Johnson BL, Shames ML, Zwiebel BR, Back MR. Duplex scan surveillance after carotid angioplasty and stenting: a rational definition of stent stenosis. J Vasc Surg. 2007;46:460–6.

    Article  Google Scholar 

  19. Fell G, Phillips D, Chikos PM, Harley JD, Thiele BL, Strandness DE Jr. Ultrasonic duplex scanning for disease of the carotid artery. Circulation. 1981;64:1191–5.

    Article  CAS  Google Scholar 

  20. Intersocietal Accreditation Commission. IAC Vascular Testing white paper on carotid stenosis interpretation criteria. Carotid Stenosis Diagnosis Criteria. January 2014;1–2.

    Google Scholar 

  21. Shaalan WE, Wahlgren CM, Desai T, Piano G, Skelly C, Bassiouny HS. Reappraisal of velocity criteria for carotid bulb/internal carotid artery stenosis utilizing high-resolution B-mode ultrasound validated with computed tomography angiography. J Vasc Surg. 2008;48:104–13.

    Article  Google Scholar 

  22. AbuRahma AF, Srivastava M, Stone PA, Mousa AY, Jain A, Dean LS, Keiffer T, Emmett M. Critical appraisal of the Carotid Duplex Consensus criteria in the diagnosis of carotid artery stenosis. J Vasc Surg. 2011;53:53–60.

    Article  Google Scholar 

  23. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–53.

    Article  Google Scholar 

  24. Arous EJ, Robinson WP, Aiello FA, Hevelone ND, Arous EJ, Messina LM, Schanzer A. Institutional differences in carotid artery duplex diagnostic criteria result in significant variability in classification of carotid artery stenoses and likely lead to disparities in care. Circ Cardiovasc Qual Outcomes. 2014;7:423–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Division of Vascular/Endovascular Surgery, West Virginia University – Charleston Division, Charleston, WV, USA

    Ali F. AbuRahma

Authors
  1. Ali F. AbuRahma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ali F. AbuRahma .

Editor information

Editors and Affiliations

  1. Department of Surgery Division of Vascular/Endovascular Surgery, West Virginia University – Charleston Division, Charleston, WV, USA

    Ali F. AbuRahma

  2. Department of Surgery, Division of Vascular Surgery and Endovascular Therapy The John Hopkins University School of Medicine, Baltimore, MD, USA

    Bruce A. Perler

Section Editor information

  1. Department of Surgery, Division of Vascular/Endovascular Surgery, West Virginia University - Charleston Division, Charleston, WV, USA

    Ali F. AbuRahma

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

AbuRahma, A.F. (2022). Carotid Duplex Consensus Criteria on Interpretation of Carotid Duplex Ultrasound. In: AbuRahma, A.F., Perler, B.A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-030-60626-8_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-60626-8_19

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-60625-1

  • Online ISBN: 978-3-030-60626-8

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation