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• W2263869537 abstract "Doppler ultrasound scanning is the first line investigation for quantifying the internal carotid artery stenosis. Nevertheless, the lack of internationally accepted ultrasound criteria for describing the degree of stenosis has contributed to the different and confusing measurements ranges. The use of two different angiographic methods, the North American Symptomatic Carotid Endoarterectomy Study and the European Carotid Surgery Trial was probably the major initial source of confusion in deriving valid and reliable duplex ultrasound criteria worldwide. The consensus proposed in 2003 by the Society of Radiologists in Ultrasound has been a great attempt to create a conformity document, establishing grey scale and Doppler criteria in considering the different degrees of stenosis. According to this attempt, in 2010, the multi-parametric Deutsche Gesellschaft für Ultraschall in der Medizin ultrasound criteria have been proposed with a precise differentiation between main and additional criteria and depicted a different peak systolic velocity (PSV) threshold. In 2012, these criteria have been implemented, focusing on the multi-parametric approach, re-defining the PSV values and clearly introducing the concept of PSV average. Despite these attempts, a wide range of practice patterns still exists, with consistent disparities in patients' care. This paper collects these previous experiences and summarizes their strengths and weaknesses, to give a contribution in the carotid artery stenosis grading standardization using ultrasonic methods. Carotid ultrasound as the only diagnostic tool for the selection of patients for carotid surgery or stenting will be possible only with internationally accepted criteria. L’eco-color Doppler dei tronchi sovra-aortici rappresenta la metodica non invasiva d’eccellenza per quantificare le stenosi carotidee. Tuttavia, la mancanza di criteri ultrasonografici di quantificazione del grado di stenosi universalmente accettati genera dati confondenti, spesso non equiparabili, con conseguente disparità di diagnosi, trattamento e costi. L’origine del dibattito ha avuto verosimilmente inizio a seguito della pubblicazione dei due maggiori trials angiografici, l’americano (NASCET) e l’europeo che definivano la quantificazione percentuale della stenosi dell’ arteria carotide interna in maniera oggettivamente differente. Il documento di consenso del 2003 della Society of Radiologists in Ultrasound è stato il primo tentativo di standardizzazione dei criteri, prendendo posizione sui valori soglia di velocità del picco sistolico nella quantificazione della stenosi e considerando come riferimento il metodo NASCET. Nel 2010, la Società Tedesca di Ultrasonologia (Deutsche Gesellschaft für Ultraschall in der Medizin, DEGUM), ha proposto un approccio di quantificazione multi-parametrico con percentuali di graduazione più definite e con differenti valori soglia di velocità rispetto alla proposta precedente prendendo in considerazione valori di velocità di picco sistolico (PSV) di 200 cm/s rispetto a PSV di 125 cm/s per stenosi NASCET del 50 %. Un’ ulteriore nuova proposta classificativa, comparsa sulla rivista Stroke nel 2012, non pare a tutt’oggi aver risolto del tutto il problema. La presenza di fatto di 2 valori soglia di PSV nettamente diversi, ha amplificato drammaticamente la disparità nella quantificazione della percentuale di stenosi. Permangono quindi evidenti discrepanze nella refertazione e nella comparabilità dei dati tra i diversi centri. Gli Autori hanno dunque tentato una rivisitazione critica delle classificazioni in uso e proposto un ulteriore contributo, nell’attesa di linee guida universalmente accettate che consentano una maggiore uniformità diagnostica." @default.
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• W2263869537 date "2016-02-01" @default.
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• W2263869537 title "Searching the perfect ultrasonic classification in assessing carotid artery stenosis: comparison and remarks upon the existing ultrasound criteria" @default.
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• W2263869537 doi "https://doi.org/10.1007/s40477-016-0193-6" @default.
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