Classification of Intracranial Stenoses: Discrepancies between Transcranial Duplex Sonography and Computed Tomography Angiography

Danyel, Leon Alexander; Hadzibegovic, Sara; Valdueza, José M.; Tietze, Anna; Fuchs, Simon; Schreiber, Stephan J.; Connolly, Florian

doi:10.1016/j.ultrasmedbio.2020.03.016

Cited by 7 publications

(2 citation statements)

References 23 publications

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“…Other studies also show a good correlation between TCCS and CTA for detecting M1 MCA stenosis ⩾ 50%. 37,38 CTA was chosen as the reference method for diagnosing ICAS in this study because of its minimally invasive, inexpensive, and easier-to-realize nature compared to the DSA.…”

Section: Discussionmentioning

confidence: 99%

Detection of moderate to severe middle cerebral artery atherosclerotic stenosis in stroke patients: Transcranial color-coded duplex sonography versus computed tomography angiography

Toudou-Daouda,

Chausson,

Smadja

et al. 2023

Ultrasound

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Background: Intracranial atherosclerotic stenosis is a common cause of ischemic cerebrovascular events and is associated with a high risk of stroke recurrence. This study aimed to assess the diagnostic accuracy of transcranial color-coded duplex sonography for moderate-to-severe middle cerebral artery stenosis in stroke patients. Methods: A retrospective analysis was carried out, including 31 patients aged ⩾18 years hospitalized for ischemic cerebrovascular event in whom middle cerebral artery stenosis ⩾30% was identified on computed tomography angiography. Transcranial color-coded duplex sonography findings were compared to the degree of stenosis blindly identified on the computed tomography angiography used as the reference method. Results: Overall, 27 patients had M1 stenosis and the other 4 had M2 stenosis. To detect M2 stenosis ⩾ 50% and ⩾ 70%, stenotic to pre-stenotic ratio ⩾ 2 and ⩾ 3 had a sensitivity of 100%, respectively. To detect M1 stenosis ⩾ 70%, peak systolic velocity ⩾ 300 cm/s had a sensitivity of 53.8% and specificity of 85.7% with area under the receiver-operating characteristic curve of 0.753 (95% confidence interval: 0.568–0.938; p = 0.026), and stenotic to pre-stenotic ratio ⩾ 3 had a sensitivity of 84.6% and a specificity of 78.6% (area under the curve = 0.854; 95% confidence interval: 0.707–1; p = 0.002). Middle cerebral artery/anterior cerebral artery velocity ratio < 0.7 had a sensitivity of 57.1% and specificity of 90% to detect dampened pre-stenotic flow in middle cerebral artery secondary to downstream M1 stenosis ⩾ 70% (area under the curve = 0.800; 95% confidence interval: 0.584–1; p = 0.040). This study showed that stenotic to pre-stenotic ratio ⩾ 3 was more sensitive than peak systolic velocity ⩾ 300 cm/s to screen M1 stenosis ⩾ 70%. Middle cerebral artery/anterior cerebral artery ratio < 0.7 was a good indirect sign to detect dampened pre-stenotic flow due to M1 stenosis ⩾ 70%.

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Section: Discussionmentioning

confidence: 99%

Detection of moderate to severe middle cerebral artery atherosclerotic stenosis in stroke patients: Transcranial color-coded duplex sonography versus computed tomography angiography

Toudou-Daouda,

Chausson,

Smadja

et al. 2023

Ultrasound

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“…In particular, ≥ 50% BAS can be defined by PSV ≥ 140 cm/s, while for ≥ 70% BAS PSV ≥ 140 cm/s associated with poststenotic flow pattern in posterior cerebral arteries [84]. These criteria are characterized by good reliability, especially for the higher degree of stenosis [85]. Moreover, it has been observed that the best diagnostic accuracy of BAS using TCCS is obtained combining PSV ≥110 cm/s, MFV ≥ 70 cm/s, and (BA PSV)/(VA PSV) ≥ 1.5 for ≥ 50% stenosis, and PSV ≥ 150 cm/s, MFV ≥ 90 cm/s, and (BA PSV)/(VA PSV) ≥ 2 for ≥ 70% stenosis [86].…”

Section: A Potential Pivotal Role For Neurosonology In Patients Selec...mentioning

confidence: 99%

The Role of Transcranial-Color-Doppler in the Management of Basilar Artery Stenosis: Case Series and Systematic Review of Literature

Filidei,

Di Schino,

Allegritti

et al. 2024

J Exp Neurol

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Managing vertebrobasilar (VB) stroke, particularly basilar artery occlusion (BAO), presents challenges due to diverse clinical presentations and intricate diagnostics, risking delays in acute-phase reperfusion therapies. The diagnostic complexities of VB stroke prompt questions about whether presentation tempo influences outcomes. For non-urgent cases of basilar artery stenosis (BAS) lacking guidelines, clinical management becomes case-dependent. Current options include aggressive medical therapy (AMT) and percutaneous transluminal angioplasty and/or stenting (PTAS). However, the choice of PTAS remains debated, with recent trials observing higher-than-expected recurrence rates, particularly in intracranial stenosis. Understanding hemodynamic status is crucial in predicting stroke risk, especially in atherosclerotic VB disease. Recent studies highlighted the role of distal flow status in predicting stroke risk, emphasizing the importance of hemodynamic assessment beyond anatomic measures. Neurosonology, especially transcranial color-coded duplex sonography (TCCS), emerges as a valuable tool for assessing hemodynamics. Despite TCCS being operator-dependent and technically challenging for BAS evaluation, it effectively detects significant hemodynamic changes, providing real-time information on collateral flow. This review explores the potential role of TCCS in managing BA hemodynamic failure in VB stroke, with particular regard to the selection of BAS patients who may benefit from PTAS.

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Evaluation of neurosonology versus digital subtraction angiography in acute stroke patients

Assarzadegan

Mohammadi

Lima

et al. 2021

Journal of Clinical Neuroscience

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Classification of Intracranial Stenoses: Discrepancies between Transcranial Duplex Sonography and Computed Tomography Angiography

Cited by 7 publications

References 23 publications

Detection of moderate to severe middle cerebral artery atherosclerotic stenosis in stroke patients: Transcranial color-coded duplex sonography versus computed tomography angiography

Detection of moderate to severe middle cerebral artery atherosclerotic stenosis in stroke patients: Transcranial color-coded duplex sonography versus computed tomography angiography

The Role of Transcranial-Color-Doppler in the Management of Basilar Artery Stenosis: Case Series and Systematic Review of Literature

Evaluation of neurosonology versus digital subtraction angiography in acute stroke patients

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