Carotid stenosis grading

A standardized systematic approach is essential for grading carotid stenosis using doppler ultrasound. It involves taking multiple parameters into consideration:

  • B mode imaging: vessel diameter, vessel area
  • plaque characterization
  • assessing color flow
  • documenting hemodynamic flow velocities at and beyond stenosis
  • understanding collateral flow status

Low degree stenosis (0% to 40%) [NASCET]

  • B-mode imaging is relevant. Measure length and thickness of plaque. Calculate diameter reduction percentage as well as residual lumen.
  • PSV ≤ 125cm/sec
  • carotid ratio (ICA PSV/CCA PSV) <2

Moderate degree stenosis (50% to 60%) [NASCET]

  • B-mode imaging is possibly relevant.
  • PSV >125cm/sec and <230cm/sec
  • collateral flow is absent
  • carotid ratio ≥2

Hemodynamically relevant stenosis (≥70%) [NASCET]

  • independent of B mode imaging
  • PSV >230cm/sec
  • EDV>100cm/sec
  • carotid ratio >4
  • post stenotic PSV
    • ≥50cm/sec – 70%
    • <50cm/sec – 80%
    • <30cm/sec – 90%
  • positive collateral flow

To summarise,

Screen Shot 2016-07-23 at 09.31.25

von Reutern, Gerhard-Michael, et al. “Grading carotid stenosis using ultrasonic methods.” Stroke43.3 (2012): 916-921.
Advertisements