A New Doppler-Derived Parameter to Quantify Internal Carotid Artery Stenosis: Maximal Systolic Acceleration

Annals of Vascular Surgery, vol. 81, pp. 202–210

Abstract

OBJECTIVE: Doppler ultrasonography (DUS) is used as initial measurement to diagnose and classify carotid artery stenosis. Local distorting factors such as vascular calcification can influence the ability to obtain DUS measurements. The DUS derived maximal systolic acceleration (ACCmax) provides a different way to determine the degree of stenosis. While conventional DUS parameters are measured at the stenosis itself, ACCmax is measured distal to the internal carotid artery (ICA) stenosis. The value of ACCmax in ICA stenosis was investigated in this study. MATERIAL AND METHODS: All carotid artery DUS studies of a tertiary academic center were reviewed from October 2007 until December 2017. Every ICA was included once. The ACCmax was compared to conventional DUS parameters: ICA peak systolic velocity (PSV), and PSV ratio (ICA PSV/ CCA PSV). ROC-curve analysis was used to evaluate accuracy of ACCmax, ICA PSV and PSV ratio as compared to CT-angiography (CTA) derived stenosis measurement as reference test. RESULTS: 0.87) were found. In ROC subanalysis, the ACCmax had a sensitivity of 90% and a specificity of 89% to diagnose a ≥70% ICA stenosis, and a sensitivity of 82% and a specificity of 88% to diagnose a ≥50% ICA stenosis. For diagnosing a ≥50% ICA stenosis the area under the curve (AUC) of ACCmax (0.88) was significantly lower than the AUC of PSV ratio (0.94) and ICA PSV (0.94). To diagnose a ≥70% ICA stenosis there were no significant differences in AUC between ACCmax (0.89), PSV ratio (0.93) and ICA PSV (0.94). CONCLUSIONS: ACCmax is an interesting additional DUS measurement in determining the degree of ICA stenosis. ACCmax is measured distal to the stenosis and is not hampered by local distorting factors at the site of the stenosis. ACCmax can accurately diagnose an ICA stenosis, but was somewhat inferior compared to ICA PSV and PSV ratio to diagnose a ≥50% ICA stenosis.

Authors 8

1. Jeroen J.W.M. Brouwers corresponding Aachen Department of Vascular Surgery

   Leiden University Medical Center · Haga Hospital

   Affiliation as printed

   Department of Vascular Surgery, Leiden University Medical Center, The Netherlands; Department of Surgery, HagaHospital, The Hague, The Netherlands. Electronic address: J.J.W.M.Brouwers@lumc.nl

   Department of Surgery, HagaHospital, The Hague, The Netherlands

   Department of Vascular Surgery, Leiden University Medical Center, The Netherlands

2. Janey Jiang Aachen Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, Leiden University Medical Center, The Netherlands

3. Robert T. Feld Aachen Department of Vascular Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Vascular Surgery, Leiden University Medical Center, The Netherlands

4. Louk P. van Doorn Aachen Department of Vascular Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Vascular Surgery, Leiden University Medical Center, The Netherlands

5. Rob C. van Wissen Aachen Department of Vascular Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Vascular Surgery, Leiden University Medical Center, The Netherlands

6. Marianne A.A. van Walderveen Aachen Department of Radiology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Radiology, Leiden University Medical Center, The Netherlands

7. Jaap F. Hamming Aachen Department of Vascular Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Vascular Surgery, Leiden University Medical Center, The Netherlands

8. Abbey Schepers Aachen Department of Vascular Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Vascular Surgery, Leiden University Medical Center, The Netherlands