Transcranial Doppler Ultrasonography of the Middle Cerebral Artery in the Hemodynamic Assessment of Internal Carotid Artery Stenosis

Kelley, Roger E.; Namon, Richard; Shing-Her-Juang,; Lee, Shih-Chang; Chang, Joshua

doi:10.1001/archneur.1990.00530090030009

Cited by 31 publications

(12 citation statements)

References 17 publications

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“…As reported by other studies, we also found a significant reduction of MCA mean blood flow velocity on the affected sides of patients with high-grade stenosis and occlusion, and a significant side-to-side difference in PI in high-grade stenosis, but not in the occlusion group (Kelley et al 1990;Wilterdink et al 1997). Accordingly, dMCA values did correlate with MCA flow velocity but not with the PI, which might have required a greater number of studied patients.…”

Section: Discussionsupporting

confidence: 87%

“…Classic ultrasonographic parameters used to evaluate hemodynamic status are the intra-and extracranial evaluation of collaterals, flow velocity, pulsatility index (PI) and the delay in systolic flow acceleration of the ipsilateral MCA, as well as the assessment of cerebral vasomotor reactivity (VMR) (Hartmann et al 2000;Kelley et al 1990;Kleiser and Widder 1992;Markus and Cullinane 2001;Ringelstein et al 1988;Wilterdink et al 1997).…”

Section: Introductionmentioning

confidence: 99%

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Delayed Transcranial Echo-Contrast Bolus Arrival in Unilateral Internal Carotid Artery Stenosis and Occlusion

Gómez-Choco

Schreiber

Weih³

et al. 2015

Ultrasound in Medicine & Biology

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Delayed Transcranial Echo-Contrast Bolus Arrival in Unilateral Internal Carotid Artery Stenosis and Occlusion

Gómez-Choco

Schreiber

Weih³

et al. 2015

Ultrasound in Medicine & Biology

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“…16 -18 It is not known how device dependent these data may be. Data on flow acceleration (FA) are limited, with the study by Kelley et al 19 representing one of the definitive reports. Recently, enzyme replacement therapy (ERT) in a single-dose phase I trial was shown to be safe and to reduce the hepatic burden of Gb 3 , whereas a randomized, double-blind, placebo-controlled trial showed a significant decrease in neuropathic pain with stabilization or improvement in renal function and a reduction in cardiac ECG abnormalities.…”

mentioning

confidence: 99%

Elevated Cerebral Blood Flow Velocities in Fabry Disease With Reversal After Enzyme Replacement

Moore

Altarescu

Ling

et al. 2002

Stroke

153

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Background and Purpose-Fabry disease is an X-linked inherited disorder resulting from a deficiency of ␣-galactosidase A. Cerebrovascular disease in Fabry disease includes small-vessel disease and larger-vessel ectasia in a predominantly posterior distribution. We assessed transcranial Doppler (TCD) blood flow velocities in naive and enzyme-treated Fabry patients. Methods-TCD was used to noninvasively examine patients with Fabry disease for abnormal cerebral blood flow velocities. TCD measurements were also made during CO 2 retention by breathholding to examine cerebrovascular vessel reactivity. Twenty-six patients were enrolled in a 6-month, double-blind, placebo-controlled trial of enzyme replacement therapy consisting of biweekly intravenous ␣-galactosidase A infusions, with a subsequent 18-month follow-up in an open-label trial. Statistical analysis consisted of applying a mixed-effects ANOVA model for correlated outcomes. Results-Peak velocity, mean velocity, pulsatility index, and resistance index were found to be significantly higher in patients compared with control subjects. When the individual vessels were considered, elevated flow velocities were found in the middle cerebral M1 branch and the posterior cerebral artery. Enzyme replacement therapy significantly decreased peak, mean, and end-diastolic velocities and flow acceleration at the 18-month follow-up time point. Conclusions-Patients

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“…A failure to detect blood flow by TCD in this setting can lead to a false-positive diagnosis of arterial occlusion [6]. Some investigators [3,7] associated slow blood flow velocity in another intracranial vessel, the middle cerebral artery, as shown on TCD, with ipsilateral ICA stenosis. Others [1,[8][9][10], however, did not find a good correlation between severe ICA stenosis and diminished middle cerebral artery blood flow velocity.…”

Section: Discussionmentioning

confidence: 99%

“…Other investigators associated certain hemodynamic changes in the ipsilateral middle cerebral artery with severe proximal ICA stenosis. These changes include diminished blood flow velocity, diminished pulsatility index, and diminished flow acceleration [1][2][3].…”

mentioning

confidence: 99%

An Absent Ophthalmic Artery or Carotid Siphon Signal on Transcranial Doppler Confirms the Presence of Severe Ipsilateral Internal Carotid Artery Disease

Wilterdink

Feldmann

Bragoni

et al. 1994

Journal of Neuroimaging

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Transcranial Doppler ultrasound provides a useful adjunct to extracranial ultrasound in the diagnosis of carotid bifurcation disease. Previous studies have shown that collateral flow patterns and diminished flow velocities in the ipsilateral middle cerebral artery correlate with hemodynamically significant carotid disease. In a series of 7,054 carotid duplex and transcranial Doppler examinations, 12.5% (95% confidence interval [CI]: 8.7, 16.4) of 287 ophthalmic arteries ipsilateral to an apparent carotid occlusion had no detectable flow signal, compared with 0.5% (95% CI: 0.3, 0.7) of 6,767 ophthalmic arteries ipsilateral to a non-occluded carotid artery (p < 0.001). Carotid siphon signals were not detectable in 24.4% (95% CI: 19.4, 29.4) of arteries ipsilateral to the carotid occlusion, versus 1.0% (95% CI: 0.8, 1.3) ipsilateral to nonoccluded carotid arteries (p < 0.001). A significant number of absent ophthalmic artery and carotid siphon signals (5.7 and 8.7%, respectively) were also found in patients with 80 to 99% extracranial carotid stenosis. A subset of 216 studies with angiographic correlation confirmed the high association of these transcranial Doppler findings with severe stenosis or occlusion of the internal carotid artery. Primary ophthalmological disease or siphon occlusion did not explain these findings. An absent ophthalmic artery or carotid siphon signal on transcranial Doppler examination is believed to represent a failure to detect slow flow distal to severe carotid bifurcation lesions. As a sign of ipsilateral carotid occlusion, the sensitivities of absent ophthalmic artery and carotid siphon signals are quite low (12.5 and 24.4%, respectively). The high specificities of 99.5 and 99.0%, however, make these findings useful in confirming the diagnosis of presumptive carotid occlusion by carotid duplex ultrasound.

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Transcranial Doppler Ultrasonography of the Middle Cerebral Artery in the Hemodynamic Assessment of Internal Carotid Artery Stenosis

Cited by 31 publications

References 17 publications

Delayed Transcranial Echo-Contrast Bolus Arrival in Unilateral Internal Carotid Artery Stenosis and Occlusion

Delayed Transcranial Echo-Contrast Bolus Arrival in Unilateral Internal Carotid Artery Stenosis and Occlusion

Elevated Cerebral Blood Flow Velocities in Fabry Disease With Reversal After Enzyme Replacement

An Absent Ophthalmic Artery or Carotid Siphon Signal on Transcranial Doppler Confirms the Presence of Severe Ipsilateral Internal Carotid Artery Disease

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