Directional C-W Doppler sonography in the diagnosis of basilar artery disease.

Abstract

Using directional continuous-wave Doppler sonography of the vertebral arteries, we have investigated 1,540 patients during the past 5 years. On the basis of unilateral and bilateral retrograde brachial angiograms in the same patients (a total of 1,989 angiograms) we have developed sonographic criteria for demonstrating a significant increase in the peripheral resistance of both distal vertebral arteries and/or the basilar artery. All 11 cases of basilar artery stenosis of at least 60% reduction in lumen diameter (as shown by angiography) exhibited an approximately 40% or higher reduction in the sum of the modified Pourcelot indices of both vertebral arteries with respect to age-matched controls. All 3 stenoses of less than 60% reduction in lumen diameter were not detected by sonography. Even a good collateral circulation through rete mirabile anastomoses did not normalize the modified Pourcelot indices. One case of a persistent primitive trigeminal artery with thin-calibered vertebral arteries was also detected by sonography. The high percent of patients with one hypoplastic vertebral artery in the group with basilar artery stenoses indicates an increased risk for atherosclerosis of the basilar and/or distal vertebral artery in these patients. All 14 angiographically verified occlusions of the basilar artery were detected by sonographic criteria independent of the occlusion localization. Thus, we believe that directional continuous-wave Doppler sonography is a reliable technique for detecting basilar artery stenoses of at least 60% reduction in lumen diameter and basilar artery occlusions. Severe intracranial stenosis of the internal carotid artery can also be diagnosed with this technique. 1 " 5 Previously, we reported the possibility of detecting a substantial increase in peripheral resistance of both distal vertebral and/or the proximal basilar arteries with Doppler pulse curves. 6 In the present study, the use of relative end-diastolic flow velocities of the vertebral arteries as circulatory resistance indices allowed, in comparison with age-matched controls, the sonographic detection of stenotic lesions of at least 60% reduction in lumen diameter in the vertebro-basilar system distal to the point of insonation. Subjects and MethodsThe present article refers to 1,540 patients exhibiting typical symptoms of atherosclerotic cerebrovascular disease, but also includes cases prior to an angiographic investigation for a suspected mass lesion or a vascular malformation. Their routine work-up included die investigation of the carotid and vertebral arteries by directional c-w Doppler sonography. All of these patients underwent at least unilateral retrograde brachial angiography. Of these, we report 29 cases with stenoses or occlusions of both distal vertebral and/or the basilar arteries. All of these 29 patients were examined with c-w Doppler sonography and bilateral retroFrom the Neurologische Klinik der Universitat Heidelberg, Heidelberg, Federal Republic of Germany.Address for reprints: Dr. Stefan Biedert, Zentral...

Ultrasound findings in spontaneous extracranial vertebral artery dissection.

“…The basilar artery was examined from a median suboccipital probe position at an insonation depth of 7.5 cm or more. 26,29,30,32,33 Analysis of Ultrasound Findings Maximal systolic and diastolic and time mean BFV were measured in each vessel. Pulsatility index (PI) was calculated according to the following formula: PI=(Systolic BFV -Diastolic BFV)/Mean BFV.…”

Headache and Neck Pain: The Warning Symptoms of Vertebral Artery Dissection

“…In many cases there is a delay between dissection, signalled by neck and head pain, and the symptoms and signs caused by the cerebral lesion. Recognition of the pain and its appropriate interpretation therefore is the clue to early diagnosis which may be confirmed noninvasively by ultra-sound, 12,13,[14][15][16][17][18] In this report we present a prospective analysis of features and time course of neck pain and headache in 14 patients with VAD proven by angiography or magnetic resonance imaging.…”

Emergency Imaging of the Acute Stroke Patient

“…Color-flow Doppler and duplex scanning have been studied as methods of evaluating vertebrobasilar disease [36][37][38][39][40][41][42], and though some have suggested that such studies may help in the determination of the occlusion site, this technique has not yet been standardized or validated.…”