Effect of Contralateral Carotid Artery Stenosis on Carotid Ultrasound Velocity Measurements.pdf

Effect of Contralateral Carotid Artery Stenosis on Carotid Ultrasound Velocity Measurements Robert D. Henderson, FRACP; David A. Steinman, PhD; Michael Eliasziw, PhD; Henry J.M. Barnett, MD; for the North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group Background and Purpose—Carotid ultrasonography is being increasingly performed as the sole investigation to assess internal carotid artery (ICA) stenosis. A potential source of error in using ultrasound peak systolic velocity (PSV) measurements is that the redistribution of blood flow due to severe stenosis in a contralateral carotid artery may lead to artificially elevated values. Methods—Ultrasonography was performed before and after carotid endarterectomy in symptomatic patients who participated in the North American Symptomatic Carotid Endarterectomy Trial (NASCET). The mean change in PSV in the unoperated artery was assessed across all degrees of angiographically defined stenosis. A simple theoretical resistance model of the cerebral circulation was also derived. Results—Complete bilateral ultrasound examinations were performed within 90 days of the initial scan in 386 patients. In the presence of a contralateral severe (70% to 99%) ICA stenosis, the PSV in the unoperated artery was artificially elevated by a mean of 84 cm/s (P50.03; 95% CI, 10 to 159 cm/s). The mean elevation was less pronounced for lesser degrees of stenosis (11 to 21 cm/s). Small elevations (3 to 12 cm/s) were observed when the contralateral artery had ,70% stenosis. The patterns of observed results were congruent with those from the theoretical model. Conclusions—The present study showed that a severely stenosed contralateral ICA can artificially elevate ultrasound PSV. Since the effect was greatest when bilaterally severe stenoses were present, caution must be exercised when assessing the degree of ICA stenosis on the basis of ultrasonography PSV measurements alone. (Stroke. 2000;31:2636-2640.) Key Words: carotid artery dise