Carotid Doppler Ultrasound Criteria for Internal Carotid Artery Stenosis Based on Residual Lumen Diameter Calculated From En Bloc Carotid Endarterectomy Specimens

Abstract

Background and Purpose Carotid duplex ultrasound is widely used to screen patients for carotid endarterectomy and if combined with MR angiography and transcranial Doppler may be an alternative to conventional angiography in the preoperative assessment. We have examined the correlation between Doppler velocities and the residual lumen diameters of internal carotid arteries from surgical pathological specimens to establish Doppler criteria for residual lumen diameter independent of percent stenosis. Methods Ninety-one patients who underwent 99 carotid endarterectomies for internal carotid artery stenosis within 6 months of their carotid duplex ultrasound evaluation were studied. The endarterectomy specimens were removed en bloc, and the minimal residual lumen diameter was calculated by computer analysis. The sensitivity and specificity of the Doppler criteria for determining high-grade stenosis were calculated and receiver-operator curves generated. Results Peak systolic velocity (PSV), end-diastolic velocity (EDV), and carotid index (peak internal carotid artery velocity/common carotid artery velocity) correlated with the residual lumen diameter. PSV >440 cm/s, EDV >155 cm/s, or carotid index >10 indicated a residual lumen diameter of ≤1.5 mm (specificity of 100% and sensitivity of 58%, 63%, and 30%, respectively). When these criteria were combined, the sensitivity increased to 72%. A PSV >200 cm/s combined with either an EDV >140 cm/s or a carotid index >4.5 has a sensitivity of 96% and a specificity of 61%. Conclusions Doppler criteria can be both specific and sensitive for detecting a significant stenosis, defined as a ≤1.5 mm residual lumen diameter. By adjustment of the velocity criteria, it can be 100% specific or a highly sensitive test (96%).