TY - JOUR
T1 - Grading carotid stenosis using ultrasonic methods
AU - Von Reutern, Gerhard Michael
AU - Goertler, Michael Wolfgang
AU - Bornstein, Natan M.
AU - Sette, Massimo Del
AU - Evans, David H.
AU - Hetzel, Andreas
AU - Kaps, Manfred
AU - Perren, Fabienne
AU - Razumovky, Alexander
AU - Von Reutern, Michael
AU - Shiogai, Toshiyuki
AU - Titianova, Ekaterina
AU - Traubner, Pavel
AU - Venketasubramanian, Narayanaswamy
AU - Wong, Lawrence K.S.
AU - Yasaka, Masahiro
PY - 2012/3
Y1 - 2012/3
N2 - The controversy as to whether Doppler ultrasonic methods should play a role in clinical decision-making in the prevention of stroke is attributable to reported disagreement between angiographic and ultrasonic results and the lack of internationally accepted ultrasound criteria for describing the degree of stenosis. Foremost among the explanations for both is the broad scatter of peak systolic velocities in the stenosis, the criterion that has so far received most attention. Grading based on a set of main and additional criteria can overcome diagnostic errors. Morphological measurements (B-mode images and color flow imaging) are the main criteria for low and moderate degrees of stenosis. Increased velocities in the stenosis indicate narrowing, but the appearance of collateral flow and decreased poststenotic flow velocity prove a high degree stenosis (≥70%), additionally allowing the estimation of the hemodynamic effect in the category of high-degree stenosis. Additional criteria refer to the effect of a stenosis on prestenotic flow (common carotid artery), the extent of poststenotic flow disturbances, and derived velocity criteria (diastolic peak velocity and the carotid ratio). This multiparametric approach is intended to increase the reliability and the standard of reporting of ultrasonic results for arteriosclerotic disease of the carotid artery.
AB - The controversy as to whether Doppler ultrasonic methods should play a role in clinical decision-making in the prevention of stroke is attributable to reported disagreement between angiographic and ultrasonic results and the lack of internationally accepted ultrasound criteria for describing the degree of stenosis. Foremost among the explanations for both is the broad scatter of peak systolic velocities in the stenosis, the criterion that has so far received most attention. Grading based on a set of main and additional criteria can overcome diagnostic errors. Morphological measurements (B-mode images and color flow imaging) are the main criteria for low and moderate degrees of stenosis. Increased velocities in the stenosis indicate narrowing, but the appearance of collateral flow and decreased poststenotic flow velocity prove a high degree stenosis (≥70%), additionally allowing the estimation of the hemodynamic effect in the category of high-degree stenosis. Additional criteria refer to the effect of a stenosis on prestenotic flow (common carotid artery), the extent of poststenotic flow disturbances, and derived velocity criteria (diastolic peak velocity and the carotid ratio). This multiparametric approach is intended to increase the reliability and the standard of reporting of ultrasonic results for arteriosclerotic disease of the carotid artery.
KW - carotid stenosis
KW - degree of stenosis
KW - duplex sonography
KW - peak systolic velocity
KW - transcranial sonography
KW - ultrasound diagnosis
UR - http://www.scopus.com/inward/record.url?scp=84857659504&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.111.636084
DO - 10.1161/STROKEAHA.111.636084
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AN - SCOPUS:84857659504
SN - 0039-2499
VL - 43
SP - 916
EP - 921
JO - Stroke
JF - Stroke
IS - 3
ER -