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Analysis of Cerebral Vasospasm in a Murine Model of Subarachnoid Hemorrhage with High Frequency Transcranial Duplex Ultrasound
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Carotid duplex with contralateral disease: the influence of vertebral artery blood flow

H J Welch1, M C Murphy, K B Raftery

  • 1Department of Vascular Surgery, Lahey Clinic, Burlington, MA 01805, USA.

Annals of Vascular Surgery
|January 12, 2000
PubMed

Insights

Severe carotid disease can affect duplex ultrasound (DU) results. Abnormal vertebral artery system (VAS) blood flow increases the risk of overestimating stenosis, impacting diagnosis and treatment decisions.

Area of Science:

  • Vascular Surgery
  • Diagnostic Imaging
  • Hemodynamics

Background:

  • Severe internal carotid artery (ICA) disease can cause hemodynamic effects that may lead to inaccurate stenosis measurements by duplex ultrasound (DU).
  • The influence of the vertebral artery system (VAS) on these duplex results in patients with severe carotid disease requires further investigation.

Purpose of the Study:

  • To examine the role of the vertebral artery system (VAS) in duplex ultrasound (DU) results for patients with severe carotid artery disease.
  • To determine if abnormal VAS impacts the accuracy of stenosis measurements and postoperative outcomes.

Main Methods:

  • Retrospective study of 110 patients undergoing carotid endarterectomy (CEA).
  • Analysis of preoperative and postoperative duplex ultrasound (DU) and angiogram data.
  • Categorization of stenosis severity (mild, moderate, severe) and assessment of ICA peak systolic velocity (PSV), end diastolic velocity (EDV), and ICA-to-CCA ratio.
  • Comparison of DU results between patients with normal and abnormal VAS.

Main Results:

  • Patients with an abnormal VAS showed significantly greater decreases in EDV post-contralateral CEA.
  • The abnormal VAS group had a higher incidence of ipsilateral stenosis overestimation by DU (23.2% vs. 16.4%) and postoperative stenosis reduction (20.9% vs. 10.4%) compared to the normal VAS group.
  • Patients with severe stenosis experienced significant postoperative decreases in ipsilateral PSV, EDV, and ICA/CCA ratio.

Conclusions:

  • Vertebral artery blood flow significantly contributes to the hemodynamic effects observed in carotid disease assessed by duplex ultrasound.
  • Abnormal VAS can lead to overestimation of carotid stenosis, highlighting the importance of considering collateral circulation in DU interpretation.
  • Accurate assessment of carotid stenosis requires consideration of the vertebral artery system's role in hemodynamic compensation.

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