Detection of vertebrobasilar intracranial stenoses: transcranial Doppler sonography versus angiography

Abstract

Vertebrobasilar intracranial stenoses seem to carry a higher risk of brain stem ischemia than proximal vertebral artery stenoses. Our aim was to assess the value of transcranial Doppler sonogr~p~y versus angiography in detecting and quantifying these intracranial stenoses. All consecutive patients who underwent transcranial Doppler sonography prior to angiography from 1989 to 1994 and whose sonograms showed a stenosis of greater than 50% of one vertebral artery (21 cases) or of the basilar artery (eight cases) were included in the study. These patients were compared with 60 other consecutive stroke patients studied via transcranial Doppler sonography prior to normal vertebrobasilar angiography. The transcranial Doppler sonographic criteria for stenosis were a peak systolic frequency shift greater than 2 KHz. A tight stenosis was identified by this pattern combined with direct and reverse I ntracranial VA and basilar artery stenoses greater than 50% in diameter were found to carry a higher risk of brain stem ischemia than low frequencies of high spectrum energy. The sensitivity of transcranial Dopr.ler sonography using a peak systolic frequency shtft in diagnosing stenoses reached 80% and its specificity was 97% if only atheromatous stenoses were considered. The main diagnostic failures concerned bilateral stenoses or contralateral occlusion, tandem lesions, and upper basilar artery stenosis. Transcranial Doppler sonography underestimated the degree of stenosis compared to angiography in 55% of the cases. We conclude that transcranial Doppler sonography is accurate in recognizing a stenOsed vessel in the intracranial vertebrobasilar circulation, but if this finding will alter therapy, the examination must be comple--mented by magnetic resonance angiography. KEY WORDS: Transcranial Doppler sonography; Angiography; Intracranial stenosis; Vertebrobasilar arteries. extracranial VA stenoses in the studies by Moufarrij and coworkers.•..l These authors observed a 27% prevalence of defined vertebrobasilar ischemia in intracranial lesions versus 0% in extracranial lesions during a 5 year average follow-up period. Moreover, these ICVB stenoses are not uncommon.3.A The prevalence of stenosis was found to be 7.7% for the basilar artery and 6.6% for the VA in an angiographic popu• lation of 4748 patients with cerebrovascular events.'Noninvasive detection using TDS complemented by magnetic resonance angiography might be the future method of choice in this field. However, few TDS studies have investigated these intracranial stenoses, and each has studied only a small series of cases.s.n The purpose of this prospective study was to assess the value of TDS versus intraarterial angiography in detecting ICVB stenoses and in determining their topographic location and their quantification.

Transcranial Doppler ultrasonographic evaluation of vertebral artery hypoplasia and aplasia

“…1). TCD was performed with 2-MHz pulsed Doppler instrument (Pioneer TC-4040, EME, Germany) according to the standard protocol [9]. VA was evaluated between 40 and 80 mm depth through suboccipital window.…”

Contrast‐Enhanced Transcranial Color‐Coded Duplex Sonography Criteria for Basilar Artery Stenosis

“…Several investigators report evaluating BA stenosis using TCD 18–20 . de Bray et al 20 suggest that the diagnostic criterion for BA stenosis is a PSV shift of greater than 80 cm/sec.…”

“…Several investigators report evaluating BA stenosis using TCD 18–20 . de Bray et al 20 suggest that the diagnostic criterion for BA stenosis is a PSV shift of greater than 80 cm/sec. When the mean flow velocity cutoff is greater than 80 cm/sec without stenosis of the ICA (≥75%), PPV and NPV of TCD for vertebrobasilar stenosis are 30% and 98%, respectively 18 …”

Die Thrombose der Arteria basilaris - eine seltene Differenzialdiagnose des Hörsturzes und des Vestibularisausfalls

“…vestibulären Symptomen bietet dabei keine ausreichende diagnostische Sicherheit. Stenosen und Verschlüsse im vertebrobasilären Gefäßsystem können mit der transkraniellen Dopplersonographie selten direkt nachgewiesen werden oder werden in mehr als 50 % der Fälle in ihrem Stenosegrad unterschätzt [10,11]. Im Zweifelsfall ist der Zeitverlust größer als der Nutzen dieser Untersuchung.…”