Correlation of hemodynamically significant internal carotid stenosis with pulsed Doppler frequency analysis

Systolic and mean pressure gradients across internal carotid stenoses were measured at the time of carotid endarterectomy in the arteries of 90 patients, all of whom underwent angiography. Eighty-two of these patients also had pulsed Doppler ultrasonic arteriography with real-time spectrum analysis. There were 71 (79%) high grade stenoses of greater than 50% diameter reduction by angiography. Significant systolic pressure gradients (greater than or equal to 10 mmHg) were identified in 41 patients (46%), 38 (46%) of whom underwent ultrasonic evaluation. A pulsed Doppler frequency measured within the stenosis equal to or greater than 6.5 kiloHertz had a sensitivity of 94.7% (36/38) in identifying pressure reducing lesions with a specificity of 47.7% (21/44). Positive predictive value was 61% (36/59). Angiographic criteria (50% diameter reduction) exhibited a sensitivity of 97.6% (40/41), a specificity of 36.7% (18/49) and a positive predictive value of 56.3% (40/71). Negative predictive value was 94.7% for angiography and 91.3% for ultrasonic arteriography. A pulsed Doppler frequency equal to or greater than 6.5 kiloHertz appears to accurately identify lesions that are at risk to reduce distal internal carotid pressure under operative conditions with a sensitivity similar to angiography. This criterion has a positive predictive value and specificity that is slightly superior to angiography and a high negative predictive value. Pulsed Doppler spectrum analysis provides physiologic information relative to blood flow velocity that is complimentary to the anatomic data provided by angiography for assessing the potential for hemodynamic significance of internal carotid stenoses.