(Stroke. 1997;28:133-136.)
© 1997 American Heart Association, Inc.
Articles |
Transcranial Doppler Ultrasound Battery Reliably Identifies Severe Internal Carotid Artery Stenosis
the Department of Clinical Neurosciences, Brown University School of Medicine, Rhode Island Hospital (Providence).
Correspondence to J.L. Wilterdink, MD, 110 Lockwood St #324, Providence, RI 02903.
Background and Purpose There is a clinical imperative for noninvasive tests for carotid disease that have high sensitivity. Previous studies have shown that transcranial Doppler ultrasound (TCD) can identify intracranial collateral flow patterns and other hemodynamic consequences of carotid occlusion. We hypothesized that a battery of such TCD findings would have a greater sensitivity than any one TCD finding alone and would have clinical utility in identifying carotid disease.
Methods We determined the prevalence of seven TCD findings in patients with various degrees of carotid stenosis as measured by a blinded observer on 138 cerebral angiograms. We further determined the sensitivity and specificity of any one finding or any single abnormality in the TCD battery (the combination of all seven findings) for identifying severe (
70%) carotid stenosis by angiography.
Results The following four individual TCD findings were associated (P<.001) with 70% carotid stenosis on cerebral angiography: ophthalmic and anterior cerebral artery flow reversal and low middle cerebral artery flow acceleration and pulsatility. The presence of any single abnormality in the TCD battery had a similar association (P<.001) with 70% carotid stenosis. The individual TCD findings had sensitivities of 3% to 83% and specificities of 60% to 100% for identifying 70% carotid stenosis. The TCD battery had a sensitivity of 95% and specificity of 42% for identifying 70% carotid stenosis.
Conclusions A battery of TCD findings that can be routinely measured reliably identified patients with 70% angiographic internal carotid artery stenosis with high sensitivity.
Key Words: carotid stenosis • cerebral angiography • duplex scanning • transcranial Doppler • ultrasonics
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