scholarly journals A Critical Evaluation of Carotid Duplex Scanning in the Diagnosis of Significant Carotid Artery Occlusive Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Jon C. Henry ◽  
Dennis Kiser ◽  
Bhagwan Satiani
Keyword(s):  
Carotid Artery ◽  
Predictive Value ◽  
Internal Carotid ◽  
Critical Evaluation ◽  
Roc Curves ◽  
Internal Carotid Artery Stenosis ◽  
Occlusive Disease ◽  
Duplex Scanning ◽  
Quality Assurance Program ◽  
Carotid Duplex

Carotid duplex (CD) scanning is the primary method of evaluating patients suspected of having extracranial carotid occlusive disease. It is incumbent on vascular laboratories (VL) to have internally validated criteria confirming overall accuracy, specificity (SP), sensitivity (SS), negative predictive value (NPV), and positive predictive value (PPV). Receiver operating characteristic (ROC) curves allow further analysis to update existing criteria. We correlated 127 internal carotid arteries studied by carotid duplex scanning and confirmatory modalities, which showed a SP of 83.3%, SS of 97.9%, NPV of 92.5%, PPV of 95%, and overall accuracy of 94.5% for >50% internal carotid artery stenosis. For >70% stenosis, SP was 88.8%, SS was 96.1%, NPV was 93.6%, PPV was 92.5%, and overall accuracy was 92.9%. ROC curves for the peak systolic velocities were used; for detecting a 50–69% stenosis range a sensitivity of 88%, specificity of 93%, NPV of 73%, and PPV of 97% were found. For detecting a 70–99% stenosis a sensitivity of 95%, specificity of 90%, NPV of 93%, and a PPV of 93% were found. All vascular laboratories must have a vigorous quality assurance program and must validate their own internal criteria or the recently promulgated consensus criteria for grading the severity of carotid stenosis by carotid duplex examination.

Duplex criteria for determining ≥50% and ≥80% internal carotid artery stenosis following carotid endarterectomy with patch angioplasty

Vascular ◽  
2011 ◽  
Vol 19 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Ali F AbuRahma
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Predictive Value ◽  
Internal Carotid ◽  
Internal Carotid Artery Stenosis ◽  
Optimal Velocity ◽  
Diastolic Velocity ◽  
Asymptomatic Patients ◽  
Sensitivity Specificity

The purpose of this study was to determine optimal velocities for detecting ≥50% and ≥80% restenosis prior to considering carotid intervention/carotid artery stenting (CAS) after carotid endarterectomy (CEA) with patching in symptomatic and asymptomatic patients. Two hundred CEA patients with 195 pairs of imaging (duplex ultrasound versus computed tomography angiography [CTA]/carotid arteriography) were analyzed. Peak systolic velocities (PSVs), end diastolic velocity (EDV) and internal carotid artery/common carotid artery (ICA/CCA) ratios were correlated to angiography. Receiver operator characteristic (ROC) curves determined optimal velocity criteria in detecting ≥50% and ≥80% restenosis. The mean PSVs for ≥50% and ≥80% restenosis were 248 and 404 c/s, respectively ( P < 0.001). A PSV of ≥213 c/s was optimal for ≥50% restenosis with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy (OA) of 99%, 100%, 100%, 98% and 99%, respectively. An ICA PSV of 274 c/s was optimal for ≥80% restenosis with sensitivity, specificity, PPV, NPV and OA of 100%, 91%, 99%, 100% and 99%, respectively. ROC analysis showed that PSVs were significantly better than EDVs and ICA/CCA ratios in detecting ≥50% restenosis. Standard duplex velocity criteria should be revised after CEA using patching. Specific carotid duplex velocities can be used to detect ≥50% and ≥80% restenosis after CEA with patch closure prior to carotid intervention/CAS.

scholarly journals Comparison between the NASCET method and subjective visual impression in the evaluation of internal carotid artery stenosis

2001 ◽  
Vol 59 (3B) ◽  
pp. 672-675 ◽  
Author(s):  
Marco Oliveira Py ◽  
Charles André ◽  
Feliciano Silva de Azevedo
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Predictive Value ◽  
Internal Carotid ◽  
Intraclass Correlation ◽  
Internal Carotid Artery Stenosis ◽  
Digital Angiography ◽  
Duplex Scan ◽  
Established Method ◽  
Visual Impression

OBJECTIVE: To evaluate the accuracy of subjective visual impression (SVI) of an experienced neuro-radiologist in the measurement of the degree of internal carotid artery (IC) stenosis evaluated by digital angiography (DGA). METHOD: Ten symptomatic patients with internal carotid stenosis greater than 70% in a previous duplex scan were submitted to DGA. The degree of stenosis in both sides (symptomatic and asymptomatic) were evaluated by the same neuro-radiologist who gave his SVI and applied the NASCET method immediately after. Both methods were compared using the intraclass correlation coeficient (r) and its 95% confidence interval (95% ci). For each method, the sample (20 ICs) was also divided in surgical (stenosis between 70 and 99%) and non surgical ICs, using kappa concordance coeficient (k) to compare the results. RESULTS: The results comparing the 20 values obtained by each method are: r = 0.90 (95% ci: 0.77 -- 0.96). Dividing the sample in surgical and non surgical ICs, k = 0.857, p < 0.0001; sensitivity = 100% (39.6% - 100%); specificity = 93.8% (67.7% - 99.7%); positive predictive value = 80% (29.9% - 98.9%); negative predictive value = 100% (74,7% - 100%). CONCLUSION: The SVI may be used by at least some experienced neuroradiologists as a preliminary tool to evaluate the degree of IC stenosis with DGA, but a standardised and well established method should be routinely performed.

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