Shmelev Artem, Darwazeh Ghaleb, Ganti Avinash, Hosseini Motahar, Beneat Amanda, Wilkerson Donald, Wilkerson Shelby, Zatina Michael
Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA.
J Community Hosp Intern Med Perspect. 2019 Dec 14;9(6):460-463. doi: 10.1080/20009666.2019.1694386. eCollection 2019.
: Duplex scanning is a useful noninvasive screening tool for the detection of carotid bifurcation disease. Internal carotid artery (ICA) peak systolic velocity (PSV) and ICA/common carotid artery (CCA) PSV ratios are proven metrics determining 70%-99% ICA stenosis. A potential disadvantage of using dramatically increasing systolic velocity measurements in areas of critical arterial stenosis is flow aliasing. Diastolic velocity should be less influenced by this flow artifact. We evaluate ICA and CCA end diastolic velocity (EDV) metrics in predicting severe ICA stenosis and document the prevalence of an aliasing artifact in a population of patients with critical ICA stenosis. : Consecutive patients undergoing carotid duplex assessments and contrast angiography were compared (n = 140). ICA and CCA PSV and EDV were recorded as was evidence of the flow aliasing of ICA waveforms. ICA/CCA PSV and EDV ratios were calculated. Duplex parameters were compared with angiographic ICA measurements. Receiver-operator characteristic curve (ROC) analysis was used to determine optimal criteria to identify ICA stenosis of 70% to 99%. : Of 256 carotid bifurcation duplex studies, critical angiographic stenosis was present in 105 arteries. Only four completed arterial duplex scans demonstrated flow aliasing. In three of these patients, systolic metrics were non-diagnostic versus ICA/CCA EDV ratios. An ICA/CCA EDV ratio of 2.3 provided the best combination of sensitivity 73.8% and specificity 75.18%. : ICA/CCA diastolic ratios reliably determine 70% or greater ICA stenosis. Flow aliasing infrequently complicates ICA PSV.
双功超声扫描是检测颈动脉分叉病变的一种有用的非侵入性筛查工具。颈内动脉（ICA）的收缩期峰值流速（PSV）以及ICA/颈总动脉（CCA）的PSV比值是已被证实的用于判定70%-99%的ICA狭窄的指标。在严重动脉狭窄区域使用急剧增加的收缩期流速测量值的一个潜在缺点是血流信号混叠。舒张期流速受这种血流伪像的影响应较小。我们评估ICA和CCA的舒张期末流速（EDV）指标在预测严重ICA狭窄方面的作用，并记录严重ICA狭窄患者群体中血流信号混叠伪像的发生率。：对接受颈动脉双功超声评估和造影血管造影的连续患者进行比较（n = 140）。记录ICA和CCA的PSV和EDV以及ICA波形血流信号混叠的证据。计算ICA/CCA的PSV和EDV比值。将双功超声参数与血管造影的ICA测量值进行比较。使用受试者工作特征曲线（ROC）分析来确定识别70%至99%的ICA狭窄的最佳标准。：在256项颈动脉分叉双功超声研究中，105条动脉存在严重的血管造影狭窄。只有4例完整的动脉双功超声扫描显示有血流信号混叠。在其中3例患者中，收缩期指标与ICA/CCA的EDV比值相比无法诊断。ICA/CCA的EDV比值为2.3时，敏感性为73.8%，特异性为75.18%，是最佳组合。：ICA/CCA舒张期比值能可靠地判定70%或更高的ICA狭窄。血流信号混叠很少使ICA的PSV变得复杂。
