Aortic & peripheral vascular disease
Variation in Ultrasound Diagnostic Thresholds for Carotid Stenosis in the United States
Authors' conclusion
The diagnostic threshold for carotid stenosis varies considerably.
Study context
- Population
- 338 accredited US vascular testing centers; thresholds applied to a population-based sample ≥65 years (Cardiovascular Health Study, n=4791) and a surgical cohort with asymptomatic carotid stenosis (Vascular Quality Initiative, n=28,483)
- Participants
- 338 accredited vascular testing centers
- Exposure
- 5th vs 95th percentile ultrasound diagnostic thresholds for carotid stenosis
- Outcome
- Variation in carotid ultrasound diagnostic thresholds and its potential impact on diagnosis
Methodological detailssurvey of testing protocols, simulation in 2 cohorts
- Survey of testing protocols
- Simulation in 2 cohorts
Main finding
As reported in the abstract
Internal carotid artery PSV diagnostic thresholds across centers
- PSV used by all centers; distinct thresholds in use
- 60
- Moderate (≥50%) stenosis PSV threshold, range
- 110 to 245 cm/s
- Moderate stenosis threshold, median (5th and 95th percentile)
- 125 (125 and 150)
- Severe (≥70%) stenosis PSV threshold, range
- 175 to 340 cm/s
- Severe stenosis threshold, median (5th and 95th percentile)
- 230 (230 and 275)
Observational data: associations, not effects.
Further findings
| Outcome | 5th percentile threshold | 95th percentile threshold | RR (CI) | |
|---|---|---|---|---|
| Diagnosis of moderate carotid stenosis, population-based sample (CHS) | 7.9% | 3.9% | 2.01 (1.70–2.38) | |
| 0.512Relative risk (log scale) |
Diagnosis of severe carotid stenosis, surgical cohort (VQI)
- Patients severe at 5th percentile centers but not at 95th
- 9.8%
- 1 in 10
Original publication
Variation in Ultrasound Diagnostic Thresholds for Carotid Stenosis in the United States. Circulation. Published 16 January 2020. doi:10.
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