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Fellow Flownetters,

I have recently begun working at a new vascular laboratory in which the
carotid stenosis criteria differs from the U. of Washington guidelines that I
have used in the past.  Briefly, here is the criteria used in this lab:

VELOCITY (m/sec)       % STENOSIS
1.3                               50
1.6                               55
1.9                               60
2.2                               65
2.5                               70
2.8                               80
3.4                               85
4.0                               90+

I am yet to learn exactly where this criteria was developed, and what study
it is based on.  If anyone has seen this before, please tell me.
     The real problem I have with this criteria is that certain radiologists
here use this not just to grade ICA stenosis, but ECA stenosis as well.  I am
unaware of any studies to back up ECA criteria.  In the past, I have "soft
called" ECA stenosis, as either less than or greater than 50%.  I look at
things such as turbulence, spectral broadening, the presence of plaque on
B-mode, and whether there is a FOCAL area of increased velocities within the
vessel to make my decision.  I was told today by a reading radiologist here
that I should be using the same criteria for both ICA and ECA stenoses.  I
have a real problem with this, and would like to dispute her on this point,
yet before doing so I would like available feed back from the great minds on
the Flownet.  Does anyone out there use this criteria for ICA and/or ECA
stenoses?  Is anyone aware of any published studies on ECA criteria?  Any
advice would be greatly appreciated.

Bryan Petrisko
Boston, MA

P.S. - Hello to all my friends in the Green Mountains.