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carotid artery (CCA) Doppler characteristics to predict ICA stenosis when the ICA cannot be insonated directly because of anatomy or calcification has not been studied. The objective of this study was to identify CCA Doppler parameters that may predict ICA stenosis. Methods: We reviewed all patients who had carotid duplex ultrasound (CDU) examination from 2008 to 2015 at our institution who also had comparison catheter, computed tomography, or magnetic resonance angiography. We collected CCA and ICA peak systolic velocity (PSV), end-diastolic velocity (EDV), and acceleration time (AT) in addition to CDU and comparison imaging degree of stenosis. A multivariate model was used to identify predictors of ICA stenosis. Results: There were 99 CDU studies examined with corresponding comparison imaging. For every 10 cm/s increase in EDV in the CCA, the odds of a >50% ICA stenosis being present vs a #50% ICA stenosis decreased by 37% (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.41-0.97; P ¼ .034). For every 10 cm/s increase in EDV in the CCA, the odds of a 70% to 99% ICA stenosis being present vs a #50% ICA stenosis decreased by 48% (OR, 0.52; 95% CI, 0.28-0.94; P ¼ .031). A CCA EDV of 19 cm/s or below is associated with a 64% probability of a 70% to 99% ICA stenosis. For every 50-millisecond increase in AT in the CCA, the odds of a >50% stenosis being present vs a #50% ICA stenosis increased by 56% (OR, 1.56; 95% CI, 1.03-2.35; P ¼ .035). A CCA AT of 800 milliseconds or above is associated with a 69% probability of >50% ICA stenosis. There was no correlation between CCA PSV and ICA stenosis. Conclusions: CCA EDV and AT are independent predictors of ICA stenosis and may be used in the setting of patients whose ICA cannot be directly insonated or when standard duplex ultrasound parameters of ICA PSV, EDV, or ICA/CCA ratio conflict.

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