Doppler Ultrasound Screening for Arterial Disease in Elderly Stroke Patients

Abstract

Doppler-shifted ultrasound and spectral analysis were used to assess the carotid arteries of 77 elderly stroke patients, which represented 154 carotid bifurcations. Severe carotid disease was demonstrated at 19 of the 154 carotid bifurcations and in eight of these complete occlusion of the internal carotid artery was present. In 12 of the 19 instances the severe disease was in the internal carotid artery associated with the stroke. Localized carotid bruits were present in five patients and only three of these were associated with severe disease of the internal carotid artery. Minor disease was detected in 80 of the 154 carotid bifurcations and no disease was detected at the remaining 55 carotid bifurcations. An abnormally low ankle/arm systolic pressure ratio, which indicated occlusive arterial disease of the legs, was obtained in 19 of the 43 patients examined. No relationship was found between the severity of carotid artery disease and the presence of haemodynamically significant disease of the lower limbs. Ultrasound measurement of aortic compliance gave significantly lower values in elderly stroke patients compared to elderly asymptomatic volunteers. Comparison of flow-velocity transit times from the stroke-affected and non-affected limbs showed no consistent effect of the stroke on vascular tone in the patients assessed.

Peripheral vascular disease—the geriatrician's tale

“…The ratio of the ankle systolic pressure to the brachial pressure is known as the pressure index (PI). A PI below 0.97 is often taken as indicating occlusive disease severe enough to reduce distal pressure (Padayachee et al, 1984). In order to avoid 'false positives' and to include only those with unequivocally significant disease, a PI of 0.75 was adopted as the lower limit of normal as this is the lowest quoted by any authority encountered (Lennihan & Mackereth, 1973).…”