Impact of 2023 Updated Intersocietal Accreditation Commission Interpretation Criteria for Carotid Stenosis on Thresholds for Treatment of Carotid Artery Disease.

Document Type

Article

Publication Date

6-12-2026

Publication Title

Journal of vascular surgery : official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter

Abstract

OBJECTIVE: In 2023, the Intersocietal Accreditation Commission (IAC) released recommendations to standardize carotid duplex ultrasound (CDU) interpretation among all non-invasive vascular laboratories. Peak systolic velocity (PSV) was recommended as the primary parameter to interpret degree of internal carotid artery (ICA) stenosis, with the threshold for ≥70% ICA stenosis of PSV>230 cm/sec. Our study evaluated the impact of adopting these updated IAC criteria for interpretation of high-grade carotid artery stenosis.

METHODS: We performed a single-center retrospective study of patients who underwent CDU from July 2021-June 2023 at an IAC-accredited outpatient vascular laboratory. PSV, end diastolic velocity (EDV), and ICA/common carotid artery (CCA) ratio were obtained for each ICA examined. The primary outcome was the proportion of ICAs with ≥70% stenosis using PSV of >230 cm/sec compared with our laboratory threshold of >275 cm/sec. ICAs were then analyzed incorporating EDV and ICA/CCA ratio and compared to interpretations using PSV alone. For generalizability, the number of ICAs from our patient dataset categorized as ≥70% stenosis based on >230 cm/sec was compared to published PSV thresholds in 10 cm/sec increments to determine at what point these changes in proportion became significantly different.

RESULTS: A total of 3141 ICAs were analyzed from 1038 patients. Adopting the IAC-recommended threshold resulted in a 52% increase in those categorized as ≥70% (266 vs 406, P< .0001) compared to our vascular laboratory PSV threshold. Adding ICA/CCA ratio>4 to the PSV criteria, this difference was 17% (176 vs 206, P< .0001). Adding EDV>100 to the PSV criterion, the increase was only 1.8% and no longer significant (114 vs 116, P=.157). Finally, adding both EDV>100 and ICA/CCA ratio>4 to the PSV criterion, the increase was 1.1% (91 vs 92, P=.317). There were no significant differences between women and men in the proportion with ≥70% stenosis at either threshold. Based on published PSV ranges from 150 cm/sec to 360 cm/sec, a total of 857 ICAs were identified as having ≥70% stenosis. Significant numbers of ICAs changed category for PSV thresholds of ≤220 cm/sec or ≥240 cm/sec, compared to the number of ICAs using 230cm/sec.

CONCLUSIONS: This study demonstrated differences in interpretation for ≥70% ICA stenosis using the updated IAC guideline of PSV >230cm/sec as the primary parameter compared to our laboratory value of 275cm/sec. A significant number of patients would change categorization from < 70% stenosis to ≥70% stenosis, potentially leading to differences in patient management. However, inclusion of EDV and ICA/CCA ratio mitigated any statistically significant difference in the number of patients recategorized, and demonstrated the importance of multiple parameters in carotid duplex ultrasound interpretation.

Volume

S0741-5214

Issue

26

First Page

01218-8

DOI

10.1016/j.jvs.2026.06.005

ISSN

1097-6809

PubMed ID

42285182

Link to Full Text

Share

COinS