Carotid stenosis reporting in Doppler ultrasound: why specifying NASCET or ECST criteria matters-an outpatient study.

Abstract

Purpose: Carotid artery stenosis represents a major risk factor for ischemic stroke, and Doppler ultrasound is widely used as the first-line imaging modality for its assessment. The degree of stenosis is commonly expressed as a percentage and can be calculated according to different methods, most notably the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and the European Carotid Surgery Trial (ECST) criteria. However, in routine clinical practice, the classification system used to determine the percentage of stenosis is not always specified in the ultrasound report. These methods consider different reference diameters, making values non-comparable and potentially misleading for clinical decisions.

Methods: In this study, we reviewed 1,400 patients evaluated in the Doppler ultrasound outpatient clinic of Internal Medicine at Poma Hospital, Mantova, Italy. All examinations were performed during routine clinical activity over four years by a physician tutor of the Italian Society of Medical and Biological Ultrasonology (SIUMB). The patient population included individuals aged between 18 and 97 years.

Results: During follow-up evaluations, it was frequently observed that previous ultrasound reports indicated a percentage of carotid stenosis without specifying whether NASCET or ECST criteria had been used.

Conclusions: Our experience highlights the importance of clearly stating the classification system used for stenosis grading in carotid Doppler reports. Standardized reporting may improve longitudinal comparison of examinations, facilitate clinical decision-making, and enhance communication among healthcare professionals involved in the management of carotid artery disease.