Peak Systolic Velocity for Calcified Plaques Fails to Estimate Carotid Stenosis Degree

Annals of Vascular Surgery
Marcia M MoralesNelson Wolosker

Abstract

Duplex ultrasonography (DUS), although consolidated as the primary tool for the estimation of carotid stenosis, may be impaired by calcified plaques that promote acoustic shadow (AcS). AcS seems to hamper the quantification of the main parameter used in the determination of percentage stenosis, that is, the maximal peak systolic velocity (PSV) at the lesion site. The aim of our study was to compare the degrees of carotid artery stenosis in DUS/PSV and computed tomography angiography (CTA) in the presence of AcS. During 36 months, 1,178 carotid DUS tests were performed. A total of 164 carotids in 139 patients showed AcS resulting from calcified plaques. Carotids with AcS were referred for a second imaging examination; thus, 62 carotids were analyzed by both DUS/PSV and CTA. CTA measured the area reduction at the lesion site to calculate the percent stenosis. PSV was measured immediately after the end of the AcS. According to velocities-based DUS criteria, stenoses were classified as mild (PSV < 125 cm/s), moderate (125 ≤ PSV ≤ 230 cm/s), and severe (PSV > 230). CTA and DUS/PSV measurements were compared to determine the accuracy of PSV in characterizing the severity of carotid stenosis with AcS. Of the 62 lesions, PSV characteri...Continue Reading

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