SAIMSARA Journal

Machine Generated Science • ISSN 3054-3991

Peak Systolic Velocity in Carotid Stenosis: Scoping Review with ☸️SAIMSARA.

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Issue 1, Volume 1, 2026

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Editorial note
• Last update: 2026-03-21 23:37:46
What is this paper about
PSV is not just a number for grading carotid stenosis—it can signal restenosis risk, hemodynamic compromise, plaque instability, and response to revascularization, but only when interpreted in the right anatomical and technical context. Read the full paper to see where PSV truly adds clinical value, where it can mislead, and how the evidence supports smarter carotid ultrasound decision-making.
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DOI: 10.62487/saimsaraa8e14259

Abstract: This paper aims to systematically synthesize the current evidence on the utility and interpretation of peak systolic velocity (PSV) in the context of carotid stenosis, identifying its diagnostic, prognostic, and therapeutic implications, as well as key areas for future research. The review utilises 153 original studies with 108064 total participants (topic deduplicated ΣN). Across the mapped evidence, PSV emerged as a clinically useful but context-sensitive marker: preprocedural PSV correlated with post-stent improvement (r = 0.622; P < 0.01), and higher baseline ICA PSV was associated with greater odds of in-stent restenosis (aOR 1.004; 95% CI 1.001 to 1.007). At the same time, multiple domains indicate that PSV can be misleading when plaque morphology or lesion geometry alters flow (e.g., lesion length effects) or when technical settings shift measured velocities, reinforcing that PSV should be interpreted alongside anatomic assessment and standardized acquisition practices. The evidence map also suggests PSV carries information beyond luminal narrowing alone, including associations with plaque instability, downstream hemodynamic compromise in high-grade disease, and measurable improvements in ocular perfusion after revascularization. Practically, these patterns support using PSV both for initial grading and for structured post-procedural surveillance, while explicitly accounting for bilateral disease effects and near-occlusion scenarios where PSV may paradoxically fall. Future research should prioritize harmonized duplex protocols and prospective, multimodal validation studies that integrate lesion geometry and plaque features to refine PSV-based decision thresholds across native stenosis and post-intervention follow-up.
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Keywords: Carotid stenosis; Peak systolic velocity; Carotid artery; Doppler ultrasound; Stenosis severity; Carotid revascularization; Ischemic stroke; In-stent restenosis; Plaque instability; Hemodynamic assessment

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