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CTA graded by near-occlusion experts was used as reference standard. Low flow velocity, unusual findings, and commonly used flow velocity parameters were analyzed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>One hundred three near-occlusions, 272 conventional \u226550% stenosis, 162 &lt;50% stenosis, and 11 occlusions were included. Carotid ultrasound was 22% (95%CI 14\u201330%; 23\/103) sensitive and 99% (95%CI 99\u2013100%; 442\/445) specific for near-occlusion diagnosis. Near-occlusions overlooked on ultrasound were found misdiagnosed as occlusions (<jats:italic>n<\/jats:italic> = 13, 13%), conventional \u226550% stenosis (<jats:italic>n<\/jats:italic> = 65, 63%) and &lt; 50% stenosis (<jats:italic>n<\/jats:italic> = 2, 2%). No velocity parameter or combination of parameters could identify the 65 near-occlusions mistaken for conventional \u226550% stenoses with &gt;75% sensitivity and specificity.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Near-occlusion is difficult to diagnose with commonly used carotid ultrasound methods. Improved carotid ultrasound methods are needed if ultrasound is to retain its position as sole preoperative modality.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00234-021-02687-x","type":"journal-article","created":{"date-parts":[[2021,3,13]],"date-time":"2021-03-13T22:02:46Z","timestamp":1615672966000},"page":"721-730","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Near-occlusion is difficult to diagnose with common carotid ultrasound methods"],"prefix":"10.1007","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5317-4563","authenticated-orcid":false,"given":"Elias","family":"Johansson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Vanoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isa","family":"Br\u00e5ten-Johansson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Law","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard I","family":"Aviv","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allan J","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,3,13]]},"reference":[{"key":"2687_CR1","first-page":"2086","volume":"26","author":"AJ Fox","year":"2005","unstructured":"Fox AJ, Eliasziw M, Rothwell PM et al (2005) Identification, prognosis, and management of patients with carotid artery near occlusion. 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