Purpose We sought to determine the diagnostic agreement between the revised ultrasonography approach by the German Society of Ultrasound in Medicine (DEGUM) and the established Society of Radiologists in Ultrasound (SRU) consensus criteria for the grading of carotid artery disease. Materials and Methods Post-hoc analysis of a prospective multicenter study, in which patients underwent ultrasonography and digital subtraction angiography (DSA) of carotid arteries for validation of the DEGUM approach. According to DEGUM and SRU ultrasonography criteria, carotid arteries were independently categorized into clinically relevant NASCET strata (normal, mild [1-49%], moderate [50-69%], severe [70-99%], occlusion). On DSA, carotid artery findings according to NASCET were considered the reference standard. Results We analyzed 158 ultrasonography and DSA carotid artery pairs. There was substantial agreement between both ultrasonography approaches for severe (κw 0.76, CI95%: 0.66-0.86), but only fair agreement for moderate (κw 0.38, CI95%: 0.19-0.58) disease categories. Compared with DSA, both ultrasonography approaches were of equal sensitivity (79.7% versus 79.7%; p=1.0) regarding the identification of severe stenosis, yet the DEGUM approach was more specific than the SRU approach (70.2% versus 56.4%, p=0.0002). There was equality of accuracy parameters (p>0.05) among both ultrasonography approaches for the other ranges of carotid artery disease. Conclusion While the sensitivity was equivalent, false-positive identification of severe carotid artery stenosis appears to be more frequent when using the SRU ultrasonography approach than the revised multiparametric DEGUM approach.