Michael Armando Palacios-Mendoza1, A García-Pastor2, A Gil-Núñez2, J M Ramírez-Moreno3, N González-Nafría4, F Moniche5, J C Portilla-Cuenca6, B Fuentes7, M A Gamero-García8, M Alonso de Leciñana9, J Masjuan9, D Canovas-Verge10, Y Aladro11, A Lago12, A M de Arce-Borda13, M Usero-Ruiz14, R Delgado-Mederos15, A Pampliega16, Á Ximenez-Carrillo17, M Bártulos-Iglesias18, E Castro-Reyes2. 1. Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain. michaelpalmend@gmail.com. 2. Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain. 3. Hospital Universitario Infanta Cristina, Neurology, Badajoz, Spain. 4. Complejo Asistencial Universitario de León, Neurology, Leon, Spain. 5. Hospital Universitario Virgen del Rocío, Sevilla, Neurology, Sevilla, Spain. 6. Hospital San Pedro Alcántara, Neurology, Cáceres, Spain. 7. Hospital Universitario La Paz, Neurology, Madrid, Spain. 8. Hospital Universitario Virgen Macarena, Neurology, Sevilla, Spain. 9. Hospital Universitario Ramón y Cajal, Neurology, Madrid, Spain. 10. Corporació Sanitaria Parc Taulí, Neurology, Sabadell, Spain. 11. Hospital Universitario de Getafe, Neurology, Getafe, Spain. 12. Hospital Universitari La Fe, Neurology, Valencia, Spain. 13. Hospital Universitario de Donostia, Neurology, Donostia, Spain. 14. Hospital Universitario de Valladolid, Neurology, Valladolid, Spain. 15. Hospital de la Santa Creu i Sant Pau, Neurology, Barcelona, Spain. 16. Hospital General Univeristario de Alicante, Neurology, Alicante, Spain. 17. Hospital Universitario de La Princesa, Neurology, Madrid, Spain. 18. Hospital Universitario de Burgos, Neurology, Burgos, Spain.
Abstract
PURPOSE: The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO. METHODS: A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)-confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR). RESULTS: One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (p < 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s, p < 0.001; 0.80 vs 1.00, p < 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%, p = 0.051). CONCLUSION: The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.
PURPOSE: The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO. METHODS: A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)-confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR). RESULTS: One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (p < 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s, p < 0.001; 0.80 vs 1.00, p < 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%, p = 0.051). CONCLUSION: The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.
Authors: Allan J Fox; Michael Eliasziw; Peter M Rothwell; Matthias H Schmidt; Charles P Warlow; Henry J M Barnett Journal: AJNR Am J Neuroradiol Date: 2005-09 Impact factor: 3.825