This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Brandt, T. Articles by Hacke, W. Search for Related Content PubMed PubMed Citation Articles by Brandt, T. Articles by Hacke, W. Related Collections Embolic stroke Computerized tomography and Magnetic Resonance Imaging Doppler ultrasound, Transcranial Doppler etc.

(Stroke. 1999;30:606-612.)
© 1999 American Heart Association, Inc.

Original Contributions

CT Angiography and Doppler Sonography for Emergency Assessment in Acute Basilar Artery Ischemia

Tobias Brandt, MD; Michael Knauth, MD; Susanne Wildermuth, MD; Ralph Winter, MD; Rüdiger von Kummer, MD; Klaus Sartor, MD Werner Hacke, MD

From the Departments of Neurology (T.B., S.W., R.W., W.H.) and Neuroradiology (M.K., R. von K., K.S.), University of Heidelberg, Heidelberg, and the Technische Universität, Dresden (R. von K.), Germany.

Correspondence to Tobias Brandt, MD, Neurologische Universitätsklinik, Im Neuenheimer Feld 400, D 69120 Heidelberg, Germany. E-mail tobias_brandt{at}ukl.uni-heidelberg.de

Background and Purpose—Both Doppler sonography (DS) and spiral CT angiography (CTA) are noninvasive vascular assessment tools with a high potential for application in acute cerebral ischemia. The usefulness of CTA for vascular diagnosis in acute basilar artery (BA) ischemia has not yet been studied.

Methods—We prospectively studied 19 patients (mean±SD age, 58±11 years) with clinically suspected acute BA occlusion by DS and CTA. Prior extracranial and transcranial DS was performed in all but 1 patient, with DS 4 hours after CTA. In 6 of 19 patients, we performed digital subtraction angiography.

Results—CTA was diagnostic in all but 1 patient. CTA revealed complete BA occlusion in 9 patients and incomplete BA occlusion with some residual flow in 2 patients. A patent BA was shown in 7 patients. Because of severe BA calcification, CTA results were inconclusive in 1 patient. DS was diagnostic in only 7 of 19 patients, indicating certain BA occlusion in 3 patients and BA patency in 4 patients. In an additional 9 patients, the results of DS were inconclusive. DS was false-negative in 2 patients with distal BA occlusion shown by CTA and digital subtraction angiography. In 1 patient with DS performed after CTA, recanalization was demonstrated. In addition to the diagnosis or exclusion of BA occlusion, CTA provided information on the exact site and length of BA occlusion and collateral pathways. In our series, CTA results prompted indication for intra-arterial thrombolysis in 5 patients.

Conclusions—CTA was superior to DS in the assessment of BA patency in patients with the syndrome of acute BA ischemia in terms of feasibility and conclusiveness, particularly in cases with distal BA occlusion. Our study confirmed the usefulness of combined extracranial and transcranial DS in the diagnosis and exclusion of proximal BA occlusion.

Key Words: angiography, computed tomographic • basilar artery • brain stem • cerebral ischemia • ultrasonography, Doppler

This article has been cited by other articles:

				V. Puetz, P.N. Sylaja, S. B. Coutts, M. D. Hill, I. Dzialowski, P. Mueller, U. Becker, G. Urban, C. O'Reilly, P. A. Barber, et al. Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion Stroke, September 1, 2008; 39(9): 2485 - 2490. [Abstract] [Full Text] [PDF]

				G. Tsivgoulis, V. K. Sharma, S. L. Hoover, A. Y. Lao, A. A. Ardelt, M. D. Malkoff, and A. V. Alexandrov Applications and Advantages of Power Motion-Mode Doppler in Acute Posterior Circulation Cerebral Ischemia Stroke, April 1, 2008; 39(4): 1197 - 1204. [Abstract] [Full Text] [PDF]

				G. Tsivgoulis, V. K. Sharma, A. Y. Lao, M. D. Malkoff, and A. V. Alexandrov Validation of Transcranial Doppler With Computed Tomography Angiography in Acute Cerebral Ischemia Stroke, April 1, 2007; 38(4): 1245 - 1249. [Abstract] [Full Text] [PDF]

				M. Matsumoto, N. Kodama, Y. Endo, J. Sakuma, Ky. Suzuki, T. Sasaki, K. Murakami, Ke. Suzuki, T. Katakura, and F. Shishido Dynamic 3D-CT Angiography AJNR Am. J. Neuroradiol., February 1, 2007; 28(2): 299 - 304. [Abstract] [Full Text] [PDF]

				C. L. Higgins, S. A. Marvel, and J. D. Morrisett Quantification of Calcification in Atherosclerotic Lesions Arterioscler. Thromb. Vasc. Biol., August 1, 2005; 25(8): 1567 - 1576. [Abstract] [Full Text] [PDF]

				S. I. Savitz and L. R. Caplan Vertebrobasilar Disease N. Engl. J. Med., June 23, 2005; 352(25): 2618 - 2626. [Full Text] [PDF]

				M. Matsumoto, N. Kodama, J. Sakuma, S. Sato, M. Oinuma, Y. Konno, K. Suzuki, T. Sasaki, K. Suzuki, T. Katakura, et al. 3D-CT Arteriography and 3D-CT Venography: The Separate Demonstration of Arterial-Phase and Venous-Phase on 3D-CT Angiography in a Single Procedure AJNR Am. J. Neuroradiol., March 1, 2005; 26(3): 635 - 641. [Abstract] [Full Text] [PDF]

				N. Hjort, K. Butcher, S.M. Davis, C.S. Kidwell, on behalf of the UCLA Thrombolysis Investigators, W.J. Koroshetz, J. Rother, P.D. Schellinger, S. Warach, and L. Ostergaard Magnetic Resonance Imaging Criteria for Thrombolysis in Acute Cerebral Infarct Stroke, February 1, 2005; 36(2): 388 - 397. [Abstract] [Full Text] [PDF]

				M. Ribo, Z. Garami, K. Uchino, J. Song, C. A. Molina, and A. V. Alexandrov Detection of Reversed Basilar Flow With Power-Motion Doppler After Acute Occlusion Predicts Favorable Outcome Stroke, January 1, 2004; 35(1): 79 - 82. [Abstract] [Full Text] [PDF]

				P. D. Schellinger, J. B. Fiebach, W. Hacke, and J. Rother Imaging-Based Decision Making in Thrombolytic Therapy for Ischemic Stroke: Present Status Stroke, February 1, 2003; 34(2): 575 - 583. [Abstract] [Full Text] [PDF]

				P. Schramm, P. D. Schellinger, J. B. Fiebach, S. Heiland, O. Jansen, M. Knauth, W. Hacke, and K. Sartor Comparison of CT and CT Angiography Source Images With Diffusion-Weighted Imaging in Patients With Acute Stroke Within 6 Hours After Onset Stroke, October 1, 2002; 33(10): 2426 - 2432. [Abstract] [Full Text] [PDF]

				N. C. Suwanwela, K. Phanthumchinda, and N. Suwanwela Transcranial Doppler Sonography and CT Angiography in Patients with Atherothrombotic Middle Cerebral Artery Stroke AJNR Am. J. Neuroradiol., September 1, 2002; 23(8): 1352 - 1355. [Abstract] [Full Text] [PDF]

				P. Verro, L. N. Tanenbaum, N. M. Borden, S. Sen, and N. Eshkar CT Angiography in Acute Ischemic Stroke: Preliminary Results Stroke, January 1, 2002; 33(1): 276 - 278. [Abstract] [Full Text] [PDF]

				G. Schulte-Altedorneburg, D. W. Droste, V. Popa, W. A. Wohlgemuth, M. Kellermann, D. G. Nabavi, L. Csiba, and E. B. Ringelstein Visualization of the Basilar Artery By Transcranial Color-Coded Duplex Sonography : Comparison With Postmortem Results Stroke, May 1, 2000; 31(5): 1123 - 1127. [Abstract] [Full Text] [PDF]

				A. M. Demchuk, I. Christou, T. H. Wein, R. A. Felberg, M. Malkoff, J. C. Grotta, and A. V. Alexandrov Specific Transcranial Doppler Flow Findings Related to the Presence and Site of Arterial Occlusion Stroke, January 1, 2000; 31(1): 140 - 146. [Abstract] [Full Text] [PDF]

				R. T.F. Cheung, T. Brandt, W. Hacke, M. Knauth, and K. Sartor Noninvasive Vascular Assessment in Suspected Acute Basilar Artery Occlusion • Response Stroke, December 1, 1999; 30 (12): 2759 - 2768. [Full Text] [PDF]