Degree of cervical carotid artery stenosis and hemispheric stroke: duplex US findings.

Abstract

Duplex ultrasound (US) scans of 110 carotid arteries ipsilateral to hemispheric strokes were compared with scans of 90 asymptomatic vessels in the same patients to determine the relative prevalence of stenotic lesions. In addition, scans of paired carotid arteries in patients with stroke involving only one cerebral hemisphere were compared to determine whether the incriminated side demonstrated a greater degree of stenosis than the asymptomatic side. The duplex US findings demonstrated a positive correlation between stenosis and hemispheric stroke. However, only 20% of carotid arteries ipsilateral to hemispheric stroke showed a reduction in diameter greater than 70%, compared with 5% of asymptomatic vessels. A minimal difference was demonstrated between the symptomatic and asymptomatic groups with respect to lesser degrees of stenosis. In paired carotid arteries, the degree of stenosis of the symptomatic vessel exceeded that of the asymptomatic vessel in only 43% of cases. These results suggest that the prevalence of severe carotid stenosis in stroke patients has been previously overestimated. The findings also emphasize the need for further investigation of other plaque-related risk factors that may enhance stroke prevention through improved selection of surgical or medical therapy. Factors currently under investigation include plaque ulceration, intraplaque hemorrhage, plaque echogenicity, and the effects of sequential stenoses.

Yield and Accuracy of Urgent Combined Carotid/Transcranial Ultrasound Testing in Acute Cerebral Ischemia

“…Three quarters of patients who had strokes, but did not qualify to receive thrombolysis, still had detectable lesions. These rates are higher than previously reported in studies using solely TCD or CD for stroke evaluation 1,3,7,21,22 likely due to combined testing at the earliest possible time after symptom onset (ie, on admission). NVUE also showed large arterial lesions in 42% of patients with TIAs.…”

Comparison of carotid artery dimensions and lesion length measured by B‐mode ultrasonography and quantitative angiography in patients with severe stenosis undergoing percutaneous revascularization

“…15 Carotid artery stenosis is an important health care problem, with an estimated prevalence of 18-20% in symptomatic patients 16,17 and 14% in asymptomatic patients referred for carotid imaging. 15 Carotid artery stenosis is an important health care problem, with an estimated prevalence of 18-20% in symptomatic patients 16,17 and 14% in asymptomatic patients referred for carotid imaging.…”

Multidimensional Risk Assessment versus Age as Criterion for Retirement of Airline Pilots

“…Non‐invasive Testing for Predicting Stroke No study was found that had examined the value of non‐invasive carotid artery testing for predicting stroke in asymptomatic subjects. Since only 20% of carotid arteries ipsilateral to hemispheric strokes show a reduction in diameter, 57 a high proportion of false‐negative results would be expected. Furthermore, the probability of future stroke was 3.4% per year in test‐positive and 1.5% per year in test‐negative referred patients, 58 suggesting that non‐invasive carotid artery testing would result in a high proportion of false‐positive test results as well.…”