A 68-year-old man presents with a 2-week history of transient monocular blindness (amaurosis fugax) in the left eye. Carotid duplex ultrasound with spectral Doppler is performed. The structure marked **B** in the diagram shows an elevated peak systolic velocity of 245 cm/s in the left internal carotid artery, with an end-diastolic velocity of 110 cm/s and an ICA/CCA PSV ratio of 4.2. According to the SRU consensus criteria, what degree of stenosis does this Doppler finding indicate?
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