Diagnostic Cerebral Angiography

Harrigan, Mark R.; Deveikis, John P.

doi:10.1007/978-1-61779-946-4_2

Cited by 9 publications

(1 citation statement)

References 84 publications

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“…DSA was performed and interpreted by neuroendovascular specialists 20 who were unaware of TCD velocity measurements. On DSA, intracranial stenosis was graded using WASID criteria for identification of the residual lumen and denominator 12 using an autocalibration technique for angiosuite workstations because it was used for on-site measurements in the SAMMPRIS trial.…”

Section: Methodsmentioning

confidence: 99%

Velocity Criteria for Intracranial Stenosis Revisited

Zhao

Barlinn

Sharma

et al. 2011

Stroke

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114

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Background and Purpose-Intracranial atherosclerotic disease is associated with a high risk of stroke recurrence. We aimed to determine accuracy of transcranial Doppler screening at laboratories that share the same standardized scanning protocol. Methods-Patients with symptoms of cerebral ischemia were prospectively studied. Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) criteria were used for identification of Ն50% stenosis. We determined velocity cutoffs for Ն70% stenosis on digital subtraction angiography by Warfarin-Aspirin Symptomatic Intracranial Disease criteria and evaluated novel stenotic/prestenotic ratio and low-velocity criteria. Results-A total of 102 patients with intracranial atherosclerotic disease (age 57Ϯ13 years; 72% men; median NationalInstitutes of Health Stroke Scale 3, interquartile range 6) provided 690 transcranial Doppler/digital subtraction angiography vessel pairs. On digital subtraction angiography, Ն50% stenosis was found in 97 and Ն70% stenosis in 62 arteries. Predictive values for transcranial Doppler SONIA criteria were similar (PϾ0.9) between middle cerebral artery (sensitivity 78%, specificity 93%, positive predictive value 73%, negative predictive value 94%, and overall accuracy 90%) and vertebral artery/basilar artery (69%, 98%, 88%, 93%, and 92%). As a single velocity criterion, most sensitive mean flow velocity thresholds for Ն70% stenosis were: middle cerebral artery Ͼ120 cm/s (71%) and vertebral artery/basilar artery Ͼ110 cm/s (55%). Optimal combined criteria for Ն70% stenosis were: middle cerebral artery Ͼ120 cm/s, or stenotic/prestenotic ratio Ն3, or low velocity (sensitivity 91%, specificity 80%, receiver operating characteristic 0.858), and vertebral artery/basilar artery Ͼ110 cm/s or stenotic/prestenotic ratio Ն3 (60%, 95%, 0.769, respectively). Conclusions-At laboratories with a standardized scanning protocol, SONIA mean flow velocity criteria remain reliably predictive of Ն50% stenosis. Novel velocity/ratio criteria for Ն70% stenosis increased sensitivity and showed good agreement with invasive angiography. (Stroke. 2011;42:3429-3434.)

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Section: Methodsmentioning

confidence: 99%