Noninvasive Detection and Evaluation of Carotid Occlusive Disease

Kartchner, Mark M.; McRae, Lorin P.; Morrison, Frank D.

doi:10.1001/archsurg.1973.01350160142024

Cited by 143 publications

(31 citation statements)

References 15 publications

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“…Of the studies which yielded conclusive data, the OPG was normal in 86% of vessels with 0-59% stenosis and abnormal in 78% of vessels with stenosis of 60% or greater. The overall diagnostic accuracy in these patients was 84% -comparable to the accuracy reported by Kartchner and co-workers, 3 ' * and by others. 8 ' 7 Unfortunately, despite the fact that patients tolerated the air-filled ocular cups of this study better than the fluid-filled system used previously, 2 the inconclusive data obtained with the digital instrument thwarted diagnosis in fully 12% of arteriographically visualized vessels in this study ( falls to 74%.…”

Section: Discussionsupporting

confidence: 85%

Limitations of quantitative oculoplethysmography and of directional Doppler ultrasonography in cerebrovascular diagnosis: assessment of an air-filled OPG system.

Ginsberg

Greenwood

Goldberg

1981

Stroke

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SUMMARY 500 consecutive patients were evaluated for extracranial disease of the internal carotid arteries by an automated, air-Ailed, digital oculoplethysmographic system (OPG) of the Kartchner type (Zira) and by supraorbital (SO) and supratrochlear (ST) directional Doppler ultrasonography. Cerebral arteriograms were performed in 58 patients (110 vessels), and OPG timing criteria for detecting hemodynamically significant carotid artery stenosis (60% or greater diameter reduction) were ascertained. Optimal criteria were a delay of one ocular pulse, relative to the other, of greater than 12 msec; and a delay of an ocular pulse, relative to the earlier ear (external carotid) pulse, of greater than 36 msec. These criteria correctly identified 73% of vessels with 0 to 59% stenosis and 76% of vessels with 60 to 100% stenosis. However, in 26% of the vessels, OPG was either inconclusive or inaccurate. Correct diagnosis of bilateral hemodynamically significant carotid artery stenoses was made by OPG in 6 of 9 affected patients. SO Doppler was normal in 70% of vessels with 0-59% stenosis, and abnormal in 75% of vessels with 60-100% stenosis. OCULOPLETHYSMOGRAPHY (OPG) and directional Doppler ultrasonography are useful techniques in the diagnosis of hemodynamically significant stenosis of the extracranial portion of the internal carotid arteries (ICA). 112 In a previous study which examined the diagnostic effectiveness of OPG and directional Doppler, we made use of an analog OPG device with fluid-filled eye cups.2 The detection of pulse delays by that system required the operator to inspect waveform tracings visually and analyze the relative position and deflection of a derived, superimposed "differential" waveform. These procedures were not amenable to quantitation, and differences of interpretation among observers were possible. In cases of bilateral hemodynamically significant ICA stenosis, reliable detection of both stenoses required the recognition of delays between an ear pulse and each of the ocular pulses. With the analog system, this could not always be accurately accomplished.For these reasons, we have assessed the diagnostic capabilities of a quantitative OPG system having air- filled cups, which employs digital microprocessor circuitry and yields direct digital data concerning the presence or absence of pulse delays, obviating the need for interpretation of waveform tracings. It was anticipated that this instrument might provide more accurate diagnosis of extracranial ICA stenoses, particularly in cases of bilateral disease. The present study assesses the strengths and limitations of quantitative OPG and compares it with directional Doppler ultrasonography of periorbital vessels and with carotid phonoangiography. MethodsThe test battery included 1) oculoplethysmography (OPG); 2) directional Doppler ultrasonography; and 3) carotid phonoangiography (CPA).In performing OPG, an automated, digital, airfilled system was employed (Zira International, Inc., Model OPG 100-A, Tucson, AZ). The corneas were first anesthet...

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Section: Discussionsupporting

confidence: 85%

Limitations of quantitative oculoplethysmography and of directional Doppler ultrasonography in cerebrovascular diagnosis: assessment of an air-filled OPG system.

Ginsberg

Greenwood

Goldberg

1981

Stroke

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“…Kartchner 3 has reported that a visible eye pulse delay correlates with a greater than 40% reduction of internal carotid artery flow. Normally internal carotid artery flow is approximately 250 cc/minute.…”

Section: Ausman and Diazmentioning

confidence: 99%

“…Phonoangiographic assessment of cervical bruits and oculoplethysmographic evaluation of ocular pulse volume changes as described by Kartchner et al 3 are STROKE VOL 13, No 3, MAY-JUNE 1982 subsequently performed. A systolic cervical bruit that lasts until diastole indicates at least a 50% area stenosis.…”

mentioning

confidence: 99%

Non-invasive evaluation of patients with extracranial to intracranial bypass.

Hayes¹,

Baker²,

Reichman³

1982

Stroke

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In selected patients with cerebrovascular insufficiency, an extracranial-intracranial bypass is indicated to increase cerebral blood flow. To assess the effect of this operation upon routine non-invasive testing, 15 patients had oculoplethysmography, carotid phonoangiography and Doppler testing. None of those with a preoperative abnormality were changed after surgery, despite angiographically proven anastomotic patency. Whereas non-invasive tests may correctly identify severe internal carotid stenosis, use of these modalities in their routine form does not predict extracranial-intracranial bypass patency.

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“…Many of the invasive techniques are based on Goldman's applanation tonometer and its variants. 6 In ocular plethysmography, 7 for example, a pressure transducer attached to a suction device that is applied to an anaesthetised eye could detect both changes in the ocular pulse amplitude as well as the pulse delays relative to the fellow eye in unilateral carotid disease. This technique, although considered expensive at the time, was characterised by relatively high sensitivity and specificity.…”

Section: Introductionmentioning

confidence: 99%

Spectral characteristics of longitudinal corneal apex velocities and their relation to the cardiopulmonary system

Kasprzak

Iskander

2006

Eye

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Purpose To study the naturally occurring kinetic characteristics of corneal surface. Methods The right eyes of three subjects (young, early presbyope, and presbyope) were examined. Cardiac signal and longitudinal corneal apex movements were simultaneously measured with electrocardiography (ECG) and a high-speed videokeratoscope, respectively. Time, frequency, and combined timefrequency representations of the acquired signals were derived to establish their temporal and spectral contents. Coherence analysis was used to assess the correlation between the corneal apex velocities and the cardiopulmonary system. Results In all measurements, longitudinal corneal apex velocity signals showed close correlation with the corresponding ECG signals. The signatures of the pulse frequency, which was inferred from the ECG spectra and their variations in time, were clearly visible in the spectral content of corneal apex velocities. For the young subject, the correlation was the strongest and all of the spectral content of the pulse signal including the harmonics was propagating to the corneal apex velocities. For the other two subjects, there was a clear propagation of the pulse signal itself but not of all pulse harmonics. Conclusions Longitudinal movements of the corneal apex are closely related to the cardiopulmonary system. The differences in propagation of pulse harmonics to the corneal apex velocities for different subjects suggest that the frequency characteristics of apex velocity could be related to pulsative variations in the intraocular pressure and biomechanical properties of the eye. These findings could potentially be used in noninvasive assessment of the hemodynamic status of the eye with high-speed videokeratoscopy.

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Noninvasive Detection and Evaluation of Carotid Occlusive Disease

Cited by 143 publications

References 15 publications

Limitations of quantitative oculoplethysmography and of directional Doppler ultrasonography in cerebrovascular diagnosis: assessment of an air-filled OPG system.

Limitations of quantitative oculoplethysmography and of directional Doppler ultrasonography in cerebrovascular diagnosis: assessment of an air-filled OPG system.

Non-invasive evaluation of patients with extracranial to intracranial bypass.

Spectral characteristics of longitudinal corneal apex velocities and their relation to the cardiopulmonary system

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