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(Stroke. 1995;26:434-438.)
© 1995 American Heart Association, Inc.

Articles

Distinguishing Carotid Artery Pseudo-Occlusion With Color-Flow Doppler

Presented at the Society of Vascular Technology 17th Annual Conference, August 3-7, 1994, Orlando, Fla.

Scott S. Berman, MD, RVT; Jenifer J. Devine, RN, RVT; Luke S. Erdoes, MD Glenn C. Hunter, MD

From the Section of Vascular Surgery, University of Arizona Health Sciences Center, Tucson, Ariz.

Correspondence to Scott S. Berman, MD, RVT, Assistant Professor of Clinical Surgery, Department of Surgery, University of Arizona Health Sciences Center, 1501 N Campbell Ave, Suite 5406, Tucson, AZ 85724.

Background and Purpose This study was undertaken to determine the impact of color-flow Doppler on the accuracy of noninvasive carotid imaging for distinguishing an internal carotid artery pseudo-occlusion (string sign) from a complete occlusion.

Methods From January 1985 to January 1994, review of noninvasive vascular studies, arteriograms, and operative reports of 26 consecutive patients undergoing 27 carotid endarterectomies for carotid pseudo-occlusion was performed. Further review was conducted of all patients identified with carotid occlusion by noninvasive testing who underwent confirmatory arteriography during the same interval.

Results Conventional gray-scale duplex scanning (January 1985 to December 1989) correctly identified 3 of 11 (27%) pseudo-occluded internal carotid arteries compared with 15 of 16 (94%) internal carotid artery pseudo-occlusions correctly identified by color-flow Doppler (January 1990 to June 1994) (P<.01). Similarly, carotid occlusion was more accurately identified by color-flow Doppler (33 of 33, 100%) compared with gray-scale duplex scanning (19 of 27, 90%) (P<.01).

Conclusions The addition of color-flow Doppler to the duplex evaluation of the extracranial carotid circulation improves the accuracy of distinguishing carotid pseudo-occlusion from the occluded internal carotid artery and may obviate the need for arteriography to identify patients with this critical level of carotid stenosis.

Key Words: carotid artery diseases • ultrasonics

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