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

David Pakizer; Anna Vybíralová; Tomáš Jonszta; Martin Roubec; Michal Král; Vendelín Chovanec; Roman Herzig; Tomáš Heryán; David Školoudík

doi:10.3389/fneur.2023.1206483

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

Front Neurol. 2023 Nov 6:14:1206483. doi: 10.3389/fneur.2023.1206483. eCollection 2023.

Authors

David Pakizer¹, Anna Vybíralová^{1

2}, Tomáš Jonszta³, Martin Roubec^{1

4}, Michal Král⁵, Vendelín Chovanec⁶, Roman Herzig^{7

8}, Tomáš Heryán⁹, David Školoudík¹

Affiliations

¹ Faculty of Medicine, University of Ostrava, Ostrava, Czechia.
² Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czechia.
³ Department of Radiology, University Hospital Ostrava, Ostrava, Czechia.
⁴ Department of Neurology, Clinic of Neurology, University Hospital Ostrava, Ostrava, Czechia.
⁵ Department of Neurology, University Hospital Olomouc, Olomouc, Czechia.
⁶ Department of Radiology, University Hospital Hradec Kralove, Hradec Králové, Czechia.
⁷ Department of Neurology, University Hospital Hradec Kralove, Hradec Kralove, Czechia.
⁸ Department of Neurology, Faculty of Medicine in Hradec Králové, Charles University, Prague, Czechia.
⁹ Department of Finance and Accounting, Silesian University in Opava, Opava, Czechia.

Abstract

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.

Keywords: atherosclerotic plaque; carotid stenosis – diagnosis; computed tomography angiography; duplex sonography; internal carotid artery; peak systolic velocity.