(Stroke. 1999;30:87-92.)
© 1999 American Heart Association, Inc.
Original Contributions |
Assessment of 
50% and <50% Intracranial Stenoses by Transcranial Color-Coded Duplex Sonography
From the Department of Neurology, University Hospital of Zürich (R.W.B.), and Departments of Neurology (H.P.M.) and Neuroradiology (G.S.), University Hospital of Bern (Switzerland).
Correspondence to Ralf W. Baumgartner, MD, Department of Neurology, University Hospital, Frauenklinikstr 26, CH-8091 Zürich, Switzerland. E-mail Strusbmg{at}neurol.unizh.ch
Background and Purpose—A
favorable risk-benefit ratio for warfarin compared with aspirin has
been reported for the prevention of major vascular events in
symptomatic 
50% intracranial stenoses.
Transcranial color-coded duplex sonography (TCCS) criteria
providing an accurate detection of 50% and <50% stenoses
of the anterior, middle, and posterior cerebral arteries and basilar
and vertebral arteries were evaluated retrospectively with angiography
used as the standard of reference.
Methods—Prospectively collected TCCS, extracranial color-coded
duplex sonography, and intra-arterial digital subtraction
angiography data of 310 patients were reviewed. The patients had
angiography for confirmation of symptomatic extracranial
70% carotid stenoses, symptomatic
stenoses (peak systolic velocity higher than the
corresponding mean value +2 SDs of 104 normal subjects), and occlusions
of the middle cerebral or basilar artery previously assessed by
ultrasound. The sonographer was not aware of angiographic findings.
Results—TCCS would have detected all 31 of 50% intracranial
stenoses with 1 false-positive and 35 of 38 <50%
stenoses with 3 false-positives. One of 69 stenoses
(1%) and 280 of 2741 normal arteries (10%) were missed because of
inadequate insonation windows. The corresponding peak systolic
velocity cutoffs for 50%/<50% stenoses were 155/120
cm/s (anterior cerebral artery), 220/155 cm/s (middle cerebral
artery), 145/100 cm/s (posterior cerebral artery), 140/100 cm/s
(basilar artery), and 120/90 cm/s (vertebral artery).
Conclusions—TCCS may reliably assess 50% and <50% basal
cerebral artery narrowing and prove useful for noninvasive management
of patients with symptomatic intracranial stenoses.
Key Words: anticoagulants • aspirin • stenosis • ultrasonography, transcranial
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