Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning

Gregory (Greg) Moneta, James Edwards, Richard W. Chitwood, Lloyd M. Taylor, Raymond W. Lee, Cary A. Cummings, John M. Porter

    Research output: Contribution to journalArticle

    373 Citations (Scopus)

    Abstract

    Purpose: The North American Symptomatic Carotid Endarterectomy Trial (NASCET) has thus far demonstrated conclusive benefit for carotid endarterectomy for patients with symptomatic 70% to 99% internal carotid artery (ICA) stenosis. In the NASCET, ICA stenosis was classified angiographically: % ICA stenosis = (1 - [narrowest ICA diameter/diameter normal distal cervical ICA]) × 100%. However, widely used duplex scan criteria for ICA stenosis correlate with different angiographic categories of high-grade stenosis (50% to 79%, > 80%) and were developed on the basis of estimated bulb diameter. We therefore blindly evaluated with separate observers carotid angiograms from 100 patients who also underwent carotid duplex scanning in our vascular laboratory. Methods: "Angiographic stenosis" was calculated as in NASCET. Duplex scan measurements of ICA peak systolic velocity (PSV), ICA end-diastolic velocity, and the ratio of ICA PSV to common carotid artery (CCA) PSV were analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy to identify a 70% to 99% ICA stenosis. Results: Analysis of the data revealed that an ICA PSV/CCA PSV ratio of 4.0 provided the best combination of sensitivity (91%), specificity (87%), positive predictive value (76%), negative predictive value (96%), and overall accuracy (88%) for detection of a 70% to 99% stenosis. Conclusion: We conclude duplex scan determination of 70% to 99% stenosis as defined in the NASCET requires the adoption of duplex criteria modified from those in current use in most vascular laboratories.

    Original languageEnglish (US)
    Pages (from-to)152-159
    Number of pages8
    JournalJournal of Vascular Surgery
    Volume17
    Issue number1
    DOIs
    StatePublished - 1993

    Fingerprint

    Carotid Endarterectomy
    Carotid Stenosis
    Internal Carotid Artery
    Pathologic Constriction
    Common Carotid Artery
    Blood Vessels
    Sensitivity and Specificity
    Angiography

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine
    • Surgery

    Cite this

    Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning. / Moneta, Gregory (Greg); Edwards, James; Chitwood, Richard W.; Taylor, Lloyd M.; Lee, Raymond W.; Cummings, Cary A.; Porter, John M.

    In: Journal of Vascular Surgery, Vol. 17, No. 1, 1993, p. 152-159.

    Research output: Contribution to journalArticle

    @article{100cff6430a94c28965fa30d13f19dfc,
    title = "Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70{\%} to 99{\%} internal carotid artery stenosis with duplex scanning",
    abstract = "Purpose: The North American Symptomatic Carotid Endarterectomy Trial (NASCET) has thus far demonstrated conclusive benefit for carotid endarterectomy for patients with symptomatic 70{\%} to 99{\%} internal carotid artery (ICA) stenosis. In the NASCET, ICA stenosis was classified angiographically: {\%} ICA stenosis = (1 - [narrowest ICA diameter/diameter normal distal cervical ICA]) × 100{\%}. However, widely used duplex scan criteria for ICA stenosis correlate with different angiographic categories of high-grade stenosis (50{\%} to 79{\%}, > 80{\%}) and were developed on the basis of estimated bulb diameter. We therefore blindly evaluated with separate observers carotid angiograms from 100 patients who also underwent carotid duplex scanning in our vascular laboratory. Methods: {"}Angiographic stenosis{"} was calculated as in NASCET. Duplex scan measurements of ICA peak systolic velocity (PSV), ICA end-diastolic velocity, and the ratio of ICA PSV to common carotid artery (CCA) PSV were analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy to identify a 70{\%} to 99{\%} ICA stenosis. Results: Analysis of the data revealed that an ICA PSV/CCA PSV ratio of 4.0 provided the best combination of sensitivity (91{\%}), specificity (87{\%}), positive predictive value (76{\%}), negative predictive value (96{\%}), and overall accuracy (88{\%}) for detection of a 70{\%} to 99{\%} stenosis. Conclusion: We conclude duplex scan determination of 70{\%} to 99{\%} stenosis as defined in the NASCET requires the adoption of duplex criteria modified from those in current use in most vascular laboratories.",
    author = "Moneta, {Gregory (Greg)} and James Edwards and Chitwood, {Richard W.} and Taylor, {Lloyd M.} and Lee, {Raymond W.} and Cummings, {Cary A.} and Porter, {John M.}",
    year = "1993",
    doi = "10.1016/0741-5214(93)90019-I",
    language = "English (US)",
    volume = "17",
    pages = "152--159",
    journal = "Journal of Vascular Surgery",
    issn = "0741-5214",
    publisher = "Mosby Inc.",
    number = "1",

    }

    TY - JOUR

    T1 - Correlation of North American Symptomatic Carotid Endarterectomy Trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning

    AU - Moneta, Gregory (Greg)

    AU - Edwards, James

    AU - Chitwood, Richard W.

    AU - Taylor, Lloyd M.

    AU - Lee, Raymond W.

    AU - Cummings, Cary A.

    AU - Porter, John M.

    PY - 1993

    Y1 - 1993

    N2 - Purpose: The North American Symptomatic Carotid Endarterectomy Trial (NASCET) has thus far demonstrated conclusive benefit for carotid endarterectomy for patients with symptomatic 70% to 99% internal carotid artery (ICA) stenosis. In the NASCET, ICA stenosis was classified angiographically: % ICA stenosis = (1 - [narrowest ICA diameter/diameter normal distal cervical ICA]) × 100%. However, widely used duplex scan criteria for ICA stenosis correlate with different angiographic categories of high-grade stenosis (50% to 79%, > 80%) and were developed on the basis of estimated bulb diameter. We therefore blindly evaluated with separate observers carotid angiograms from 100 patients who also underwent carotid duplex scanning in our vascular laboratory. Methods: "Angiographic stenosis" was calculated as in NASCET. Duplex scan measurements of ICA peak systolic velocity (PSV), ICA end-diastolic velocity, and the ratio of ICA PSV to common carotid artery (CCA) PSV were analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy to identify a 70% to 99% ICA stenosis. Results: Analysis of the data revealed that an ICA PSV/CCA PSV ratio of 4.0 provided the best combination of sensitivity (91%), specificity (87%), positive predictive value (76%), negative predictive value (96%), and overall accuracy (88%) for detection of a 70% to 99% stenosis. Conclusion: We conclude duplex scan determination of 70% to 99% stenosis as defined in the NASCET requires the adoption of duplex criteria modified from those in current use in most vascular laboratories.

    AB - Purpose: The North American Symptomatic Carotid Endarterectomy Trial (NASCET) has thus far demonstrated conclusive benefit for carotid endarterectomy for patients with symptomatic 70% to 99% internal carotid artery (ICA) stenosis. In the NASCET, ICA stenosis was classified angiographically: % ICA stenosis = (1 - [narrowest ICA diameter/diameter normal distal cervical ICA]) × 100%. However, widely used duplex scan criteria for ICA stenosis correlate with different angiographic categories of high-grade stenosis (50% to 79%, > 80%) and were developed on the basis of estimated bulb diameter. We therefore blindly evaluated with separate observers carotid angiograms from 100 patients who also underwent carotid duplex scanning in our vascular laboratory. Methods: "Angiographic stenosis" was calculated as in NASCET. Duplex scan measurements of ICA peak systolic velocity (PSV), ICA end-diastolic velocity, and the ratio of ICA PSV to common carotid artery (CCA) PSV were analyzed for sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy to identify a 70% to 99% ICA stenosis. Results: Analysis of the data revealed that an ICA PSV/CCA PSV ratio of 4.0 provided the best combination of sensitivity (91%), specificity (87%), positive predictive value (76%), negative predictive value (96%), and overall accuracy (88%) for detection of a 70% to 99% stenosis. Conclusion: We conclude duplex scan determination of 70% to 99% stenosis as defined in the NASCET requires the adoption of duplex criteria modified from those in current use in most vascular laboratories.

    UR - http://www.scopus.com/inward/record.url?scp=0027410697&partnerID=8YFLogxK

    UR - http://www.scopus.com/inward/citedby.url?scp=0027410697&partnerID=8YFLogxK

    U2 - 10.1016/0741-5214(93)90019-I

    DO - 10.1016/0741-5214(93)90019-I

    M3 - Article

    C2 - 8421332

    AN - SCOPUS:0027410697

    VL - 17

    SP - 152

    EP - 159

    JO - Journal of Vascular Surgery

    JF - Journal of Vascular Surgery

    SN - 0741-5214

    IS - 1

    ER -