Differentiating subtotal carotid artery stenoses from occlusions by colour-coded duplex sonography

Görtler, Michael; Niethammer, Rainer; Widder, Bernhard

doi:10.1007/bf00868437

Cited by 62 publications

(38 citation statements)

References 10 publications

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“…Carotid artery stenoses were categorized into high grade (≥ 70%) and moderate grade (50%-69%) according to the criteria of NASCET. 5,15,31 When necessary, angiography was performed to determine the exact degree of the stenosis or to carry out intraarterial thrombolysis.…”

Section: Patientsmentioning

confidence: 99%

Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

Mono¹,

Steiger²,

Findling³

et al. 2013

JNS

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Object The risk of recurrence of cerebrovascular events within the first 72 hours of admission in patients hospitalized with symptomatic carotid artery (CA) stenoses and the risks and benefits of emergency CA intervention within the first hours after the onset of symptoms are not well known. Therefore, the authors aimed to assess 1) the ipsilateral recurrence rate within 72 hours of admission, in the period from 72 hours to 7 days, and after 7 days in patients presenting with nondisabling stroke, transient ischemic attack (TIA), or amaurosis fugax (AF), and with an ipsilateral symptomatic CA stenosis of 50% or more, and 2) the risk of stroke in CA interventions within 48 hours of admission versus the risk in interventions performed after 48 hours. Methods Ninety-four patients were included in this study. These patients were admitted to hospital within 48 hours of a nondisabling stroke, TIA, or AF resulting from a symptomatic CA stenosis of 50% or more. The patients underwent carotid endarterectomy (85 patients) or CA stenting (9 patients). At baseline, the cardiovascular risk factors of the patients, the degree of symptomatic CA stenosis, and the type of secondary preventive treatment were assessed. The in-hospital recurrence rate of stroke, TIA, or AF ipsilateral to the symptomatic CA stenosis was determined for the first 72 hours after admission, from 72 hours to 7 days, and after 7 days. Procedure-related cerebrovascular events were also recorded. Results The median time from symptom onset to CA intervention was 5 days (interquartile range 3.00–9.25 days). Twenty-one patients (22.3%) underwent CA intervention within 48 hours after being admitted. Overall, 15 recurrent cerebrovascular events were observed in 12 patients (12.8%) in the period between admission and CA intervention: 3 strokes (2 strokes in progress and 1 stroke) (3.2%), 5 TIAs (5.3%), and 1 AF (1.1%) occurred within the first 72 hours (total 9.6%) of admission; 1 TIA (1.1%) occurred between 72 hours and 7 days, and 5 TIAs (5.3%) occurred after more than 7 days. The corresponding actuarial cerebrovascular recurrence rates were 11.4% (within 72 hours of admission), 2.4% (between 72 hours and 7 days), and 7.9% (after 7 days). Among baseline characteristics, no predictive factors for cerebrovascular recurrence were identified. Procedure-related cerebrovascular events occurred at a rate of 4.3% (3 strokes and 1 TIA), and procedures performed within the first 48 hours and procedures performed after 48 hours had a similar frequency of these events (4.5% vs 4.1%, respectively; p = 0.896). Conclusions The in-hospital recurrence of cerebrovascular events was quite low, but all recurrent strokes occurred within 72 hours. The risk of stroke associated with a CA intervention performed within the first 48 hours was not increased compared with that for later interventions. This raises the question of the optimal timing of CA intervention in symptomatic CA stenosis. To answer this question, more data are needed, preferably from large randomized trials.

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Section: Patientsmentioning

confidence: 99%

Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

Mono¹,

Steiger²,

Findling³

et al. 2013

JNS

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“…Such a lesion can also produce compensatory increased flow velocities in the contralateral hemisphere, thereby increasing the asymmetry index. 41,59 To ascribe an intracranial flow reduction to intracranial pathology, an upstream obstruction of the ICA an has to be ruled out. Figure 3.…”

Section: Upstream Obstructionmentioning

confidence: 99%

Consensus Recommendations for Transcranial Color-Coded Duplex Sonography for the Assessment of Intracranial Arteries in Clinical Trials on Acute Stroke

Nedelmann

Stolz

Gerriets

et al. 2009

Stroke

138

112

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Background and Purpose-Transcranial color-coded duplex sonography has become a standard diagnostic technique to assess the intracranial arterial status in acute stroke. It is increasingly used for the evaluation of prognosis and the success of revascularization in multicenter trials. The aim of this international consensus procedure was to develop recommendations on the methodology and documentation to be used for assessment of intracranial occlusion and for monitoring of recanalization.

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“…Dampened, pseudovenous flow with low pulsatility is highly specific as published in Mansour et al, 45 with only 1 false-positive with distal occlusion. A flow profile with systolic triangular spikes and no diastolic flow can be either distal occlusion or stenosis 5,18,45,47 or near-occlusion with full collapse 12,18,67,76 ; the sonography report should reflect this uncertainty. Systolic spikes with reversed diastolic flow have been reported in a small series.…”

mentioning

confidence: 99%

Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

Johansson

Fox

2015

AJNR Am J Neuroradiol

105

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SUMMARY:Carotid near-occlusion is distal ICA luminal collapse beyond a tight stenosis, where the distal lumen should not be used for calculating percentage stenosis. Near-occlusion with full ICA collapse is well-known, with a threadlike lumen. However, near-occlusion without collapse is often subtle and can be overlooked as a usual severe stenosis. More than 10 different terms have been used to describe near-occlusion, sometimes causing confusion. This systematic review presents what is known about carotid near-occlusion. In this first part, the foci are definition, terminology, and diagnosis. ABBREVIATION: ECA ϭ external carotid artery

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Differentiating subtotal carotid artery stenoses from occlusions by colour-coded duplex sonography

Cited by 62 publications

References 10 publications

Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

Risk of very early recurrent cerebrovascular events in symptomatic carotid artery stenosis

Consensus Recommendations for Transcranial Color-Coded Duplex Sonography for the Assessment of Intracranial Arteries in Clinical Trials on Acute Stroke

Carotid Near-Occlusion: A Comprehensive Review, Part 1—Definition, Terminology, and Diagnosis

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