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Assessment of Stenosis: Implications of Variability of Doppler Measurements in Normal-appearing Carotid Arteries¹

¹ From the Department of Radiology, Duke University Medical Center, PO Box 3808, Durham, NC. Received August 13, 1998; revision requested September 25; revision received October 21; accepted January 11, 1999. Address reprint requests to V.S.L., Department of Radiology-MRI, New York University Medical Center, 530 First Ave, HCC Basement, New York, NY 10016.

PURPOSE: To examine the variability of Doppler measurements along the extracranial courses of the nondiseased common carotid artery (CCA) and internal carotid artery (ICA) and determine the effect of this variability on assessment of carotid arterial stenosis.

MATERIALS AND METHODS: During the study period, 580 patients were referred for carotid arterial ultrasonography (US), including Doppler measurements of flow velocities in the proximal, middle, and distal portions of the CCA, in the bulb, and in the proximal and distal portions of the ICA. Eighty-five patients (average age, 59 years) with normal ICAs and CCAs formed the cohort for this study.

RESULTS: The range of peak systolic velocity (PSV) measurements (maximum minus minimum) averaged 20 cm/sec ± 13 in the CCA and 15 cm/sec ± 13 in the ICA. ICA/CCA velocity ratios varied, depending on the CCA measurement location. In five arteries, PSV ratios exceeded a threshold of 1.8 (suggesting 60% stenosis); in 23 arteries, end diastolic velocity ratios exceeded a threshold of 2.4 (also suggesting 60% stenosis). Right-to-left CCA PSV ratios were abnormal in up to 26 patients (suggesting >50% ICA stenosis), depending on where CCA measurements were obtained. When the CCA ratios were obtained at the same level, 16 were in the abnormal range.

CONCLUSION: Variability of Doppler measurements in the CCA and ICA in patients without visible disease is substantial and could lead to inaccuracies in carotid arterial stenosis assessment.

Index terms: Carotid arteries, flow dynamics, 172.12984 • Carotid arteries, stenosis or obstruction, 172.721 • Carotid arteries, US, 172.12983, 172.12984

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