Peak systolic velocity ratio for evaluation of internal carotid artery stenosis correlated with plaque morphology: substudy results of the ANTIQUE study

• Published in: Frontiers in neurology Vol. 14
• Main Authors: Pakizer, David, Vybíralová, Anna, Jonszta, Tomáš, Roubec, Martin, Král, Michal, Chovanec, Vendelín, Herzig, Roman, Heryán, Tomáš, Školoudík, David
• Format: Journal Article
• Language: English
• Published: Frontiers Media S.A 06-11-2023
• Subjects: atherosclerotic plaque; carotid stenosis – diagnosis; computed tomography angiography; duplex sonography; internal carotid artery; peak systolic velocity
• ISSN: 1664-2295; 1664-2295
• DOI: 10.3389/fneur.2023.1206483

Background
Accurate assessment of carotid stenosis severity is important for proper patient management. The present study aimed to compare the evaluation of carotid stenosis severity using four duplex sonography (DUS) measurements, including peak systolic velocity (PSV), PSV ratio in stenosis and distal to stenosis (PSV
ICA/ICA
ratio), end-diastolic velocity (EDV), and B-mode, with computed tomography angiography (CTA), and to evaluate the impact of plaque morphology on correlation between DUS and CTA.
Methods
Consecutive patients with carotid stenosis of ≥40% examined using DUS and CTA were included. Plaque morphology was also determined using magnetic resonance imaging. Spearman’s correlation and Kendall’s rank correlation were used to evaluate the results.
Results
A total of 143 cases of internal carotid artery stenosis of ≥40% based on DUS were analyzed. The PSV
ICA/ICA
ratio showed the highest correlation [Spearman’s correlation
r
 = 0.576) with CTA, followed by PSV (
r
 = 0.526), B-mode measurement (
r
 = 0.482), and EDV (
r
 = 0.441;
p
 < 0.001 in all cases]. The worst correlation was found for PSV when the plaque was calcified (
r
 = 0.238), whereas EDV showed a higher correlation (
r
 = 0.523). Correlations of B-mode measurement were superior for plaques with smooth surface (
r
 = 0.677), while the PSV
ICA/ICA
ratio showed the highest correlation in stenoses with irregular (
r
 = 0.373) or ulcerated (
r
 = 0.382) surfaces, as well as lipid (
r
 = 0.406), fibrous (
r
 = 0.461), and mixed (
r
 = 0.403;
p
 < 0.01 in all cases) plaques. Nevertheless, differences between the mentioned correlations were not statistically significant (
p
> 0.05 in all cases).
Conclusion
PSV, PSV
ICA/ICA
ratio, EDV, and B-mode measurements showed comparable correlations with CTA in evaluation of carotid artery stenosis based on their correlation with CTA results. Heavy calcifications and plaque surface irregularity or ulceration negatively influenced the measurement accuracy.