Detection of common carotid artery stenosis using duplex ultrasonography: A validation study with computed tomographic angiography

David P. Slovut, Javier M. Romero, Kathleen M. Hannon, James Dick, Michael R. Jaff

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Background: Severe stenosis of the common carotid artery (CCA), while uncommon, is associated with increased risk of transient ischemic attack and stroke. To date, no validated duplex ultrasound criteria have been established for grading the severity of CCA stenosis. The goal of this study was to use receiver-operating curve (ROC) analysis with computed tomographic angiography as the reference standard to establish duplex ultrasound criteria for diagnosing ≥50% CCA stenosis. Methods: The study cohort included 64 patients (42 men, 22 women) with a mean age of 65 ± 12 years (range, 16-89 years) who had CCA peak systolic velocity (PSV) ≥150 cm/sec and underwent computed tomographic angiography (CTA) of the cervical and intracerebral vessels within 1 month of the duplex examination. One study was excluded because the CTA was technically inadequate, whereas another was excluded because the patient underwent bilateral CCA stenting. The CCA ipsilateral to any of the following was excluded from the analysis: innominate artery occlusion (n = 1), previous stenting of the ICA or CCA (n = 7), carotid endarterectomy (n = 1), or carotid-to-carotid bypass (n = 1). Thus, the data set included 62 patients and 115 vessels. Bland-Altman analysis was used to examine the agreement between two measures of luminal reduction measured by CTA: percent diameter stenosis and percent area stenosis. Receiver operating characteristic (ROC) analysis was used to determine optimal PSV and EDV thresholds for diagnosing ≥50% CCA stenosis. Results: Severity of CCA stenosis was <50% in 76 vessels, 50%-59% in eight, 60%-69% in eight, 70%-79% in nine, 80%-89% in three, 90%-99% in five, and occluded in six. Duplex ultrasonography identified six of six (100%) patients with 100% CCA occlusion by CTA. Bland-Altman analysis showed poor agreement between percent stenosis determined by vessel diameter compared with percent stenosis determined by reduction in lumen area. Therefore, subsequent analysis was performed using percent stenosis by area. ROC analysis of different PSV thresholds for detecting stenosis ≥50% showed that >182 cm/sec was the most accurate with a sensitivity of 64% and specificity of 88% (P < .0001). Sensitivity, specificity, and accuracy of carotid duplex were higher when the stenosis was located in the mid or distal aspects of the CCA (sensitivity 76%, specificity 89%, area under curve 0.84, P < .001) than in the intrathoracic and proximal segment of the artery (P = NS). ROC analysis of different EDV thresholds for detecting CCA stenosis ≥50% showed that >30 cm/sec was the most accurate with a sensitivity of 54% and a specificity of 74% (P < .0239). Conclusions: Duplex ultrasonography is highly sensitive, specific, and accurate for detecting CCA lesions in the mid and distal CCA. Use of peak systolic velocity may lead to improved detection of CCA disease and initiation of appropriate therapy to reduce the risk of stroke.

Original languageEnglish (US)
Pages (from-to)65-70
Number of pages6
JournalJournal of Vascular Surgery
Volume51
Issue number1
DOIs
StatePublished - Jan 2010
Externally publishedYes

Fingerprint

Validation Studies
Carotid Stenosis
Common Carotid Artery
Ultrasonography
Angiography
Pathologic Constriction
Stroke
Brachiocephalic Trunk
Carotid Artery Diseases
Carotid Endarterectomy
Transient Ischemic Attack
ROC Curve
Cohort Studies
Sensitivity and Specificity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Detection of common carotid artery stenosis using duplex ultrasonography : A validation study with computed tomographic angiography. / Slovut, David P.; Romero, Javier M.; Hannon, Kathleen M.; Dick, James; Jaff, Michael R.

In: Journal of Vascular Surgery, Vol. 51, No. 1, 01.2010, p. 65-70.

Research output: Contribution to journalArticle

Slovut, David P. ; Romero, Javier M. ; Hannon, Kathleen M. ; Dick, James ; Jaff, Michael R. / Detection of common carotid artery stenosis using duplex ultrasonography : A validation study with computed tomographic angiography. In: Journal of Vascular Surgery. 2010 ; Vol. 51, No. 1. pp. 65-70.
@article{60dc050a041d420d97c471f82d5bc6a1,
title = "Detection of common carotid artery stenosis using duplex ultrasonography: A validation study with computed tomographic angiography",
abstract = "Background: Severe stenosis of the common carotid artery (CCA), while uncommon, is associated with increased risk of transient ischemic attack and stroke. To date, no validated duplex ultrasound criteria have been established for grading the severity of CCA stenosis. The goal of this study was to use receiver-operating curve (ROC) analysis with computed tomographic angiography as the reference standard to establish duplex ultrasound criteria for diagnosing ≥50{\%} CCA stenosis. Methods: The study cohort included 64 patients (42 men, 22 women) with a mean age of 65 ± 12 years (range, 16-89 years) who had CCA peak systolic velocity (PSV) ≥150 cm/sec and underwent computed tomographic angiography (CTA) of the cervical and intracerebral vessels within 1 month of the duplex examination. One study was excluded because the CTA was technically inadequate, whereas another was excluded because the patient underwent bilateral CCA stenting. The CCA ipsilateral to any of the following was excluded from the analysis: innominate artery occlusion (n = 1), previous stenting of the ICA or CCA (n = 7), carotid endarterectomy (n = 1), or carotid-to-carotid bypass (n = 1). Thus, the data set included 62 patients and 115 vessels. Bland-Altman analysis was used to examine the agreement between two measures of luminal reduction measured by CTA: percent diameter stenosis and percent area stenosis. Receiver operating characteristic (ROC) analysis was used to determine optimal PSV and EDV thresholds for diagnosing ≥50{\%} CCA stenosis. Results: Severity of CCA stenosis was <50{\%} in 76 vessels, 50{\%}-59{\%} in eight, 60{\%}-69{\%} in eight, 70{\%}-79{\%} in nine, 80{\%}-89{\%} in three, 90{\%}-99{\%} in five, and occluded in six. Duplex ultrasonography identified six of six (100{\%}) patients with 100{\%} CCA occlusion by CTA. Bland-Altman analysis showed poor agreement between percent stenosis determined by vessel diameter compared with percent stenosis determined by reduction in lumen area. Therefore, subsequent analysis was performed using percent stenosis by area. ROC analysis of different PSV thresholds for detecting stenosis ≥50{\%} showed that >182 cm/sec was the most accurate with a sensitivity of 64{\%} and specificity of 88{\%} (P < .0001). Sensitivity, specificity, and accuracy of carotid duplex were higher when the stenosis was located in the mid or distal aspects of the CCA (sensitivity 76{\%}, specificity 89{\%}, area under curve 0.84, P < .001) than in the intrathoracic and proximal segment of the artery (P = NS). ROC analysis of different EDV thresholds for detecting CCA stenosis ≥50{\%} showed that >30 cm/sec was the most accurate with a sensitivity of 54{\%} and a specificity of 74{\%} (P < .0239). Conclusions: Duplex ultrasonography is highly sensitive, specific, and accurate for detecting CCA lesions in the mid and distal CCA. Use of peak systolic velocity may lead to improved detection of CCA disease and initiation of appropriate therapy to reduce the risk of stroke.",
author = "Slovut, {David P.} and Romero, {Javier M.} and Hannon, {Kathleen M.} and James Dick and Jaff, {Michael R.}",
year = "2010",
month = "1",
doi = "10.1016/j.jvs.2009.08.002",
language = "English (US)",
volume = "51",
pages = "65--70",
journal = "Journal of Vascular Surgery",
issn = "0741-5214",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Detection of common carotid artery stenosis using duplex ultrasonography

T2 - A validation study with computed tomographic angiography

AU - Slovut, David P.

AU - Romero, Javier M.

AU - Hannon, Kathleen M.

AU - Dick, James

AU - Jaff, Michael R.

PY - 2010/1

Y1 - 2010/1

N2 - Background: Severe stenosis of the common carotid artery (CCA), while uncommon, is associated with increased risk of transient ischemic attack and stroke. To date, no validated duplex ultrasound criteria have been established for grading the severity of CCA stenosis. The goal of this study was to use receiver-operating curve (ROC) analysis with computed tomographic angiography as the reference standard to establish duplex ultrasound criteria for diagnosing ≥50% CCA stenosis. Methods: The study cohort included 64 patients (42 men, 22 women) with a mean age of 65 ± 12 years (range, 16-89 years) who had CCA peak systolic velocity (PSV) ≥150 cm/sec and underwent computed tomographic angiography (CTA) of the cervical and intracerebral vessels within 1 month of the duplex examination. One study was excluded because the CTA was technically inadequate, whereas another was excluded because the patient underwent bilateral CCA stenting. The CCA ipsilateral to any of the following was excluded from the analysis: innominate artery occlusion (n = 1), previous stenting of the ICA or CCA (n = 7), carotid endarterectomy (n = 1), or carotid-to-carotid bypass (n = 1). Thus, the data set included 62 patients and 115 vessels. Bland-Altman analysis was used to examine the agreement between two measures of luminal reduction measured by CTA: percent diameter stenosis and percent area stenosis. Receiver operating characteristic (ROC) analysis was used to determine optimal PSV and EDV thresholds for diagnosing ≥50% CCA stenosis. Results: Severity of CCA stenosis was <50% in 76 vessels, 50%-59% in eight, 60%-69% in eight, 70%-79% in nine, 80%-89% in three, 90%-99% in five, and occluded in six. Duplex ultrasonography identified six of six (100%) patients with 100% CCA occlusion by CTA. Bland-Altman analysis showed poor agreement between percent stenosis determined by vessel diameter compared with percent stenosis determined by reduction in lumen area. Therefore, subsequent analysis was performed using percent stenosis by area. ROC analysis of different PSV thresholds for detecting stenosis ≥50% showed that >182 cm/sec was the most accurate with a sensitivity of 64% and specificity of 88% (P < .0001). Sensitivity, specificity, and accuracy of carotid duplex were higher when the stenosis was located in the mid or distal aspects of the CCA (sensitivity 76%, specificity 89%, area under curve 0.84, P < .001) than in the intrathoracic and proximal segment of the artery (P = NS). ROC analysis of different EDV thresholds for detecting CCA stenosis ≥50% showed that >30 cm/sec was the most accurate with a sensitivity of 54% and a specificity of 74% (P < .0239). Conclusions: Duplex ultrasonography is highly sensitive, specific, and accurate for detecting CCA lesions in the mid and distal CCA. Use of peak systolic velocity may lead to improved detection of CCA disease and initiation of appropriate therapy to reduce the risk of stroke.

AB - Background: Severe stenosis of the common carotid artery (CCA), while uncommon, is associated with increased risk of transient ischemic attack and stroke. To date, no validated duplex ultrasound criteria have been established for grading the severity of CCA stenosis. The goal of this study was to use receiver-operating curve (ROC) analysis with computed tomographic angiography as the reference standard to establish duplex ultrasound criteria for diagnosing ≥50% CCA stenosis. Methods: The study cohort included 64 patients (42 men, 22 women) with a mean age of 65 ± 12 years (range, 16-89 years) who had CCA peak systolic velocity (PSV) ≥150 cm/sec and underwent computed tomographic angiography (CTA) of the cervical and intracerebral vessels within 1 month of the duplex examination. One study was excluded because the CTA was technically inadequate, whereas another was excluded because the patient underwent bilateral CCA stenting. The CCA ipsilateral to any of the following was excluded from the analysis: innominate artery occlusion (n = 1), previous stenting of the ICA or CCA (n = 7), carotid endarterectomy (n = 1), or carotid-to-carotid bypass (n = 1). Thus, the data set included 62 patients and 115 vessels. Bland-Altman analysis was used to examine the agreement between two measures of luminal reduction measured by CTA: percent diameter stenosis and percent area stenosis. Receiver operating characteristic (ROC) analysis was used to determine optimal PSV and EDV thresholds for diagnosing ≥50% CCA stenosis. Results: Severity of CCA stenosis was <50% in 76 vessels, 50%-59% in eight, 60%-69% in eight, 70%-79% in nine, 80%-89% in three, 90%-99% in five, and occluded in six. Duplex ultrasonography identified six of six (100%) patients with 100% CCA occlusion by CTA. Bland-Altman analysis showed poor agreement between percent stenosis determined by vessel diameter compared with percent stenosis determined by reduction in lumen area. Therefore, subsequent analysis was performed using percent stenosis by area. ROC analysis of different PSV thresholds for detecting stenosis ≥50% showed that >182 cm/sec was the most accurate with a sensitivity of 64% and specificity of 88% (P < .0001). Sensitivity, specificity, and accuracy of carotid duplex were higher when the stenosis was located in the mid or distal aspects of the CCA (sensitivity 76%, specificity 89%, area under curve 0.84, P < .001) than in the intrathoracic and proximal segment of the artery (P = NS). ROC analysis of different EDV thresholds for detecting CCA stenosis ≥50% showed that >30 cm/sec was the most accurate with a sensitivity of 54% and a specificity of 74% (P < .0239). Conclusions: Duplex ultrasonography is highly sensitive, specific, and accurate for detecting CCA lesions in the mid and distal CCA. Use of peak systolic velocity may lead to improved detection of CCA disease and initiation of appropriate therapy to reduce the risk of stroke.

UR - http://www.scopus.com/inward/record.url?scp=72549085860&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=72549085860&partnerID=8YFLogxK

U2 - 10.1016/j.jvs.2009.08.002

DO - 10.1016/j.jvs.2009.08.002

M3 - Article

C2 - 19879097

AN - SCOPUS:72549085860

VL - 51

SP - 65

EP - 70

JO - Journal of Vascular Surgery

JF - Journal of Vascular Surgery

SN - 0741-5214

IS - 1

ER -