Joint Recommendations for Reporting Carotid Ultrasound Investigations in the United Kingdom

Abstract

At present in the United Kingdom a number of different criteria are used to grade disease in carotid ultrasound investigations. One main cause of this has been the difference in the method of grading angiograms used in the NASCET and ECST large carotid surgery trials. It is desirable that all centres reporting carotid ultrasound investigations report to the same standard. This paper presents recommendations for the reporting of ultrasound investigations of the extra cranial arteries produced by a Joint Working Group formed between the Vascular Society of Great Britain and Ireland, and the Society for Vascular Technology of Great Britain and Ireland. The recommended criteria are based on the NASCET method of grading carotid bulb disease. Key recommendations include recording peak systolic velocity (PSV) and end-diastolic velocity (EDV) in both internal and distal common carotid arteries; measuring all velocities at a Doppler angle of 45-60 degrees; the use of internal carotid PSV of >1.25 ms(-1) and >2.3 ms(-1) and a Peak Systolic Velocity Ratio of >2 and >4 to indicate >50% and >70% stenosis respectively; and the use of the St Mary's Ratio to grade >50% stenoses in deciles. General recommendations are also given for the acquisition, interpretation and reporting of the data.

Unprotected Carotid Artery Stenting in Symptomatic Patients with High-Grade Stenosis: Results and Long-Term Follow-Up in a Single-Center Experience

“…Doppler criterion for Ն70% stenosis was a peak systolic velocity of Ͼ230 cm/s. 16,17 Stenosis degree was confirmed by angiography in all cases.…”

Clinical Significance of Fluid-Attenuated Inversion Recovery Vascular Hyperintensities in Transient Ischemic Attack

“…Assessments of extracranial internal carotid arteries on digital subtraction angiography, MRA, and carotid echography were made by North American Symptomatic Carotid Endarterectomy Trial (NASCET)-based methodology. 15 Stenosis in major intracranial arteries on digital subtraction angiography and MRA was evaluated by Warfarin Aspirin Symptomatic Intracranial Disease (WASID)-style methodology. 16 An AOL was defined as >50% stenosis, or as occlusion of extra-and intracranial large arteries assessed by MRA or digital subtraction angiography without recanalization on the followup examination.…”

Retinal Vascular Caliber and Extracranial Carotid Disease in Patients With Acute Ischemic Stroke

“…Carotid disease was determined by the degree of stenosis alone without using criteria for velocities, because this was not available in one center. Although velocities are recommended for carotid stenosis assessment, 26 the sensitivity and specificity of duplex alone are fair compared with angiography (72% and 92% for stenosis 80% to 99%, 92% and 99% for complete occlusion). 27 Second, there was some selection bias in the stroke cohort, because severely ill patients were excluded because they could not undergo retinal photography.…”