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- Title
Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study.
- Authors
Palacios-Mendoza, Michael Armando; García-Pastor, A.; Gil-Núñez, A.; Ramírez-Moreno, J. M.; González-Nafría, N.; Moniche, F.; Portilla-Cuenca, J. C.; Fuentes, B.; Gamero-García, M. A.; Alonso de Leciñana, M.; Masjuan, J.; Canovas-Verge, D.; Aladro, Y.; Lago, A.; de Arce-Borda, A. M.; Usero-Ruiz, M.; Delgado-Mederos, R.; Pampliega, A.; Ximenez-Carrillo, Á.; Bártulos-Iglesias, M.
- 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.
- Subjects
RESEARCH; SCIENTIFIC observation; DIGITAL subtraction angiography; CAROTID artery stenosis; COLLATERAL circulation; MEDICAL cooperation; TRANSCRANIAL Doppler ultrasonography; SEVERITY of illness index; CEREBRAL arteries; DESCRIPTIVE statistics; HEMODYNAMICS; LONGITUDINAL method; SYMPTOMS
- Publication
Neuroradiology, 2021, Vol 63, Issue 5, p705
- ISSN
0028-3940
- Publication type
Article
- DOI
10.1007/s00234-020-02567-w