The main parameter that should be used in diagnosing and grading the internal carotid artery (ICA) hemodynamic stenosis is the peak systolic velocity (PSV), but grading based only on the PSV is not sufficient to differentiate a moderate from a severe (70% NASCET) stenosis with sufficient clinical reliability. In these cases the PSV criterion taken alone is of limited value.
Grading based on a set of main and additional criteria can overcome diagnostic errors: in particular it is recommended the study of the post stenotic flow velocity distal to flow disturbances and the study of the collateral flows through the anterior/posterior communicating artery.
In this lesson are reported: A) the recommendations proposed by two Consensus Panels (1. Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003; and 2. Neurosonology Research Group of the World Federation of Neurology. Stroke 2012) in order to provide reliable information regarding the diagnosis of the degree of ICA stenosis; B) some explicative case reports.
Franco Accorsi, MD
Member of the Order of Physician of Bologna n° 6728
I am a specialist in Medical Angiology and I am based in Bologna, Italy. Until 2008 (voluntary resignation) I worked at Maggiore Hospital in Bologna as "Dirigente Medico" in the Department of Internal Medicine and as Angiologist in the Angiology Unit with a position of "Alta Professionalità" in "Vascular Ecography and Angiology".
I am currently working in Bologna as an independent professional in the areas of angiology and vascular diagnostics.
I have been a speaker at national and international courses/congress and I have taught duplex ultrasound method in GIUV and SIUMB courses at the Maggiore Hospital, Bologna and courses of echocolor Doppler of extracranial and intracranial arteries at the Stroke Unit of S. Maria Nuova Hospital, Reggio Emilia.