Ultrasonic duplex scanning for disease of the carotid artery.

Fell, Gary; Phillips, David J.; Chikos, P M; Harley, J. D.; Thiele, B L; Strandness, D. Eugene

doi:10.1161/01.cir.64.6.1191

Cited by 204 publications

(46 citation statements)

References 8 publications

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“…The main problems are the investigation of the proximal part of the vertebral artery and the differentiation of severe stenosis, occlusion, hypoplasia and aplasia (von Reutern et al, 1976, Hennerici et al, 1981. Ultrasonic duplex scanning with spectral analysis of the Doppler signal is a very reliable technique for the detection of carotid atherosclerosis (Fell et al, 1981;Breslau, 1982;Ackerstaff et al, 1982). To date no reports are available about the accuracy of duplex ultrasound scanning of the innominate, subclavian and vertebral arteries.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonic duplex scanning in atherosclerotic disease of the innominate, subclavian and vertebral arteries. A comparative study with angiography

Ackerstaff

Hoeneveld

Slowikowski

et al. 1984

Ultrasound in Medicine & Biology

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Abstract-Ultrasonic duplex scanning of the vertebral artery has a sensitivity of 0.80 and a specificity of 0.83 for the detection of an obstructive lesion of 50% or more at the site of the ostium. For the subclavian arteries these values are respectively 0.73 and 0.91. For both vessels the test has a very high negative predictive value of respectively 0.96 and 0.97. Therefore duplex ultrasound scanning is a reliable test in screening patients suspected of multi-level atherosclerotic disease of the extracranial cerebral vessels. The problem remains in classifying the degree of stenosis. In the case of the vertebral artery the sample volume of the pulsed Doppler is usually too large in relation to the vessel diameter. In the case of the subclavian and innominate artery one of the main problems is the range of the pulsed Doppler system. A subclavian steal syndrome is easily diagnosed without any special test.

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Section: Discussionmentioning

confidence: 99%

Ultrasonic duplex scanning in atherosclerotic disease of the innominate, subclavian and vertebral arteries. A comparative study with angiography

Ackerstaff

Hoeneveld

Slowikowski

et al. 1984

Ultrasound in Medicine & Biology

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“…Previous studies have shown that an increase in spectral broadening during systole without a concomitant increase in peak systolic frequency is a useful feature to predict disease states of <50% diameter reduction by arteriography. 2 Peak systolic flow velocities of > 120 cm/sec in the proximal ICA correlate well with disease of >50% diameter reduction. This threshold value was empirically obtained using a 5-MHz ultrasound duplex system at a Doppler angle of 60°i n the proximal ICA while assuming an axial direction for the flow velocity vector.…”

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confidence: 94%

Diagnostic significance of flow separation in the carotid bulb.

Nicholls

Phillips

Primozich

et al. 1989

Stroke

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Pulsatile blood flow within the normal carotid sinus involves at least two distinct components. That near the flow divider is laminar and antegrade, whereas a boundary layer separation zone in the posterolateral aspect exhibits transient blood flow reversal. It is now possible to document these flow velocity components using pulsed Doppler ultrasound methods. When atherosclerosis develops, it preferentially involves the posterolateral bulb region, obliterating the normal configuration of the sinus with consequent loss of the flow separation zone. It was therefore hypothesized that if flow separation could be detected, it should be predictive of a normal angiogram. To assess this, we evaluated 20 symptomatic patients and two with only bruits found by duplex scanning to have flow separation in either one or both carotid bulbs and who also underwent cerebral angiography. Initial diagnoses were stroke in seven, reversible ischemic neurologic deficit in one, transient ischemic attack in 12, and bruit in two. Flow separation was bilateral in 13 patients (59%). There were 15 patients with symptoms in the territory of a carotid bulb exhibiting flow separation. By angiography, of the 35 bulbs with boundary layer separation, 27 (77%) were normal, with the remainder snowing lesions that reduced the diameter of the vessel by 20% or less. Final diagnoses of the 15 patients with symptoms ipsilateral to a carotid sinus exhibiting flow separation were fibromuscular disease in two, lacunar stroke in three, dissection in two, subclavian steal in one, cardiogenic embolus in three, migraine in one, hyperventilation syndrome in one, kink of the mid-internal carotid artery in one, and no diagnosis in one. A normal ultrasound image coupled with flow separation in the carotid bulb in patients presenting with presumptive extracramal carotid disease is therefore shown to be associated with minimal or no carotid atherosclerotic disease on angiography and to reliably predict etiology other than carotid artery disease for the symptoms. (Stroke 1989;20:175-182) C arotid bifurcation disease has been previously quantified by identifying features of blood flow velocity patterns obtained with ultrasound from the proximal internal carotid artery (ICA) and correlating them with the "gold standard" of contrast arteriography.

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“…39 The variables for classifying the degree of stenosis into these groups depend upon the recorded peak frequencies from the diseased area as well as the time of onset and degree of spectral broadening. After several validation studies, we decided to use the spectral criteria shown in Table 1.…”

Section: Direct Testsmentioning

confidence: 99%