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OPTIMAL CAROTID DUPLEX VELOCITY CRITERIA IN DEFINING THE SEVERITY OF CAROTID IN-STENT RESTENOSIS.

Background/Purpose
The optimal duplex velocities criteria to determine in-stent carotid restenosis is controversial. We previously reported the optimal duplex velocities for > 30% in-stent restenosis. This prospective study will further classify the severity of in-stent restenosis.

Patient Population/Methods
144 patients who underwent carotid artery stenting as a part of clinical trials were analyzed. All patients had completion arteriograms and underwent post-op carotid duplex ultrasound, which was repeated at 1 month and every 6 months thereafter. Patients with peak systolic velocities of the ICA of > 130 cm/sec underwent carotid CT/ angiogram. Peak systolic velocities and end diastolic velocities of the ICA and CCA and peak systolic velocity of ICA/CCA ratios were recorded. ROC analysis was used to determine the optimal velocities criteria for the diagnosis of > 30%, >50% and >80% restenosis.

Results
Mean follow-up was 20 month (Range 0-78). 220 pairs of imaging (Duplex Ultrasound versus CTA/Angio) were available for analysis.

Accuracy of CTA versus Carotid Arteriogram was confirmed in subset of patients (22) (r2= 0.9).

Mean peak systolic velocity for patients with >30%,>50%, and >80% stenosis of stented arteries based on CTA/Angio were 153 , 217, 325 cm/sec respectively.

ROC analysis demonstrated that an ICA peak systolic velocity of > 153 cm/sec was optimal for >30 stenosis with sensitivity of 98%, specificity of 93%, PPV of 97% and NPV of 95%; ICA peak systolic velocity of > 217 cm/sec was optimal for >50% stenosis with sensitivity of 100%, specificity of 100%, PPV of 100% and NPV of 100%; ICA peak systolic velocity of > 325 was optimal for >80% stenosis with sensitivity of 100%, specificity of 100%, PPV of 100% and NPV of 100%. The peak systolic velocity of the stented artery was better predictor for in-stent restenosis than the end diastolic velocity or the ICA-CCA ratio.

Conclusions
The optimal duplex velocities criteria for in-stent restenosis of > 30%, >50% and >80% were the peak systolic velocities of 153, 217, 325 cm/sec respectively.