Vertebral artery doppler sonography

Abstract

We have examined the vertebral and subclavian arteries in 1,205 patients using directional continuous-wave (c-w) Doppler sonography, and compared the sonographic findings with the results of unilateral or bilateral retrograde brachial arteriographies in the same patients. Doppler sonography revealed 33 false positives among 909 cases with normal angiographic findings. Some types of vertebral artery (VA) lesions allowed an excellent, others a fairly good differentiation by Doppler sonography: the complete subclavian steal syndrome with constant reversal of VA flow was reliably detected (16 cases). In the incomplete steal syndrome (5 cases) sonography was superior to angiography. Two bilateral distal VA occlusions and seven basilar artery occlusions - six in the proximal third and one in the rostral third - were detected sonographically; four basilar occlusions sparing the caudal third and one case exhibiting rete mirabile anastomoses were not identified by Doppler sonography. Our acoustically defined sonographic criteria did not permit an unequivocal assignment to an anatomical variant or a vascular lesion. The sensitivity in the detection of a severe stenosis at the VA origin amounted to 16 out of 31, and to 12 of 25 in cases with a proximal VA occlusion and reconstitution of the distal VA through cervical collaterals. Our results confirm that the conventional hand-held c-w Doppler sonography cannot replace angiography in the evaluation of vertebro-basilar insufficiency. It rather serves as an aid to the decision for or against angiography, and in the follow-up of angiographically proven lesions. However, several therapeutically important lesions are readily diagnosed by sonography.

Duplex ultrasound in the subclavian steal syndrome

“…WINTER et al (21) found that the complete subclavian steal syndrome with a constant reversal of vertebral artery flow was reliably detected (1 6 cases), and in an incomplete steal syndrome (5 cases) CW sonography proved superior to angiography. In their angiographically examined cases, VON REUTERN & POURCELOT (1 5) visualized a complete reverse flow with CW in 93.8% of the cases of subclavian occlusion, and a partially reverse flow in 80.4% of the cases of subclavian stenosis.…”

Duplex Doppler Ultrasonography of Subclavian Steal Syndrome-Three Case Reports-

“…16) Therefore, the diastolic reversal``to-andfro pattern'' indicates the stenosis of the subclavian artery. Steal phenomenon should be suspected if ultrasonography demonstrates the reflux pattern with diastolic flow deceleration, as in our Case 3.…”