A New Doppler-Derived Parameter to Quantify Internal Carotid Artery Stenosis: Maximal Systolic Acceleration

Brouwers, Jeroen J.W.M.; Jiang, Janey; Feld, Robert T.; Doorn, Louk P. van; Wissen, Rob C. van; Walderveen, Marianne A.A. van; Hamming, Jaap F.; Schepers, Abbey

doi:10.1016/j.avsg.2021.09.056

Cited by 7 publications

(3 citation statements)

References 29 publications

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“…AT, in its simplest definition, is arguably the most convenient variable for routine assessment. However, measurements referring to the first part of the upslope, i.e., to the maximal acceleration, yielded better results for the detection of carotid and renal artery stenosis [18,[21][22][23][24]. Maximal acceleration, at the very beginning of the systolic upslope, is not affected by reflected waves and other confounding factors.…”

Section: Measurement Methodsmentioning

confidence: 97%

Arterial Blood-Flow Acceleration Time on Doppler Ultrasound Waveforms: What Are We Talking About?

Trihan

Laroche

Dauzat

et al. 2023

JCM

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In recent years, the assessment of systolic acceleration in lower-extremity peripheral artery disease (PAD) has been brought back into the spotlight, whatever measure is used: time (in s) or acceleration (in cm.s−2). Acceleration time (also called systolic rise time) and maximal acceleration are two different but very useful measurements of growing interest in PAD. A background of the historical development, physics rationale, semantics, and methods of measurement, as well as their strengths and weaknesses, are discussed herein. Acceleration time is a powerful tool for predicting significant arterial stenosis or for estimating the overall impact of PAD as it is highly correlated to the ankle or toe pressure indexes. It could even become a new diagnostic criterion for critical limb ischemia. Similarly, maximal systolic acceleration ratios are highly predictive of carotid or renal stenosis. However, the literature lacks reference standards or guidelines for the assessment of such variables, and their measurement techniques seem to differ between authors. We propose herein a semantic and measurement statement order to clarify and help standardize future research.

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Section: Measurement Methodsmentioning

confidence: 97%

Arterial Blood-Flow Acceleration Time on Doppler Ultrasound Waveforms: What Are We Talking About?

Trihan

Laroche

Dauzat

et al. 2023

JCM

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“…Acceleration measurements are used in the clinic for vascular remodeling [ 22 , 23 ], and have been previously inaccessible in mice. To longitudinally quantify blood flow acceleration in vein grafts of C57BL/6J and ApoE3*Leiden, ACCsys and ACCmax were identified ( Figure 4 A) [ 24 , 25 ].…”

Section: Resultsmentioning

confidence: 99%

Visualization of Murine Vascular Remodeling and Blood Flow Dynamics by Ultra-High-Frequency Ultrasound Imaging

Sier

Jong

Quax

et al. 2022

IJMS

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Vein grafts (VGs) are used to bypass atherosclerotic obstructions and arteriovenous fistulas (AVFs) as vascular access for hemodialysis. Vascular remodeling governs post-interventional arterialization, but may also induce VG and AVF failure. Although the endpoint characteristics of vascular remodeling are known, the in vivo process and the role of blood flow dynamics has not been fully studied. Therefore, here we non-invasively quantify vascular remodeling and blood flow alterations over time in murine VG and AVF models. C57BL/6J (n = 7, chow diet) and atherosclerosis-prone ApoE3*Leiden (n = 7) mice underwent VG surgery. Ultrasound imaging was performed at 3, 7, 14, 21, and 28 days post-surgery. C57BL/6J mice (n = 8) received AVF surgery. Ultrasound imaging was performed at 7 and 14 days post-surgery. The luminal volume increased by 42% in the VGs of C57BL/6J and 38% in the VGs of ApoE3*Leiden mice at 28 days relative to 3 days post-surgery. Longitudinally, an 82% increase in wall volume and 76% increase in outward remodeling was found in the ApoE3*Leiden mice, with a constant wall size in C57BL/6J mice. Proximally, the pulsatility index, resistive index, and peak systolic velocity decreased longitudinally in both groups. Distally, the maximum acceleration increased with 56% in C57BL/6J VGs. Among the AVFs, 50% showed maturation after 7 days, based on a novel flow-criterium of 23 mL/min. Distinct flow patterns were observed at the anastomotic site and inflow artery of the AVFs relative to the control carotid arteries. Vascular remodeling can be quantified by ultra-high-frequency ultrasound imaging over time in complex animal models, via three-dimensional structural parameters and site-specific hemodynamic indices.

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“…AT and maximal acceleration have long been described as predictive of severe arterial disease, particularly in renal artery stenosis, [27][28][29][30] but have recently come to the fore again, particularly in quantifying the severity of peripheral artery disease in carotid artery disease 31,32 and lower-extremity artery disease. 10,12,13,33 In this study, we confirm the great interest of this AT max in the diagnosis of either low TP or CLTI.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia

Trihan,

Croquette,

Hersant

et al. 2024

Vasc Med

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Introduction: Maximal acceleration time of distal arteries of the foot (ATmax) is correlated to ankle–brachial index (ABI) and toe–brachial index (TBI), and seems very promising in diagnosing severe peripheral artery disease (PAD) and especially critical limb-threatening ischemia (CLTI). Our goal was to confirm the cut-off value of 215 ms to predict a toe pressure (TP) ⩽ 30 mmHg. Methods: A 4-month retrospective study was conducted on patients addressed for suspicion of PAD. Demographic data, ABI, TBI, and Doppler ultrasound scanning parameters of the dorsal pedis and lateral plantar arteries (DPA and LPA) were recorded. Results: A total of 137 patients with 258 lower limbs were included. ATmax was highly correlated to TBI ( r = −0.89, p < 0.001). With the cut-off value of 215 ms, ATmax was effective to diagnose TP ⩽ 30 mmHg with a sensitivity of 93% [95% CI 77–99], a specificity of 96% [95% CI 92–98], a positive predictive value of 73% [95% CI 56–86], a negative predictive value of 99% [95% CI 97–100], and an area under the receiver operating characteristics curve of 0.99 [95% CI 0.98–1.00]. ATmax also showed promising results to rule out PAD in healthy patients. Conclusion: ATmax is a reliable diagnostic tool to diagnose low TP and could be a new easily performed hemodynamic criterion for diagnosis of CLTI.

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A New Doppler-Derived Parameter to Quantify Internal Carotid Artery Stenosis: Maximal Systolic Acceleration

Cited by 7 publications

References 29 publications

Arterial Blood-Flow Acceleration Time on Doppler Ultrasound Waveforms: What Are We Talking About?

Arterial Blood-Flow Acceleration Time on Doppler Ultrasound Waveforms: What Are We Talking About?

Visualization of Murine Vascular Remodeling and Blood Flow Dynamics by Ultra-High-Frequency Ultrasound Imaging

Accuracy of maximal acceleration time of pedal arteries to diagnose critical limb-threatening ischemia

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