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Vertebral artery Doppler waveform changes indicating subclavian steal physiology
M A Kliewer1, B S Hertzberg, D H Kim
1Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
AJR. American Journal of Roentgenology
|March 4, 2000
Summary
New waveform patterns in antegrade vertebral arteries may signal early subclavian steal syndrome. These distinct waveform types correlate with abnormal hemodynamics and subclavian disease.
Area of Science:
- Vascular Ultrasound
- Doppler Echocardiography
- Cerebrovascular Physiology
Background:
- Subclavian steal syndrome (SSS) involves reversed blood flow in the subclavian artery.
- Early detection of SSS is crucial for preventing neurological complications.
- Vertebral artery (VA) waveform analysis can provide insights into proximal arterial hemodynamics.
Purpose of the Study:
- To characterize and classify changes in antegrade VA waveforms.
- To identify early indicators of subclavian steal physiology.
- To correlate waveform changes with the presence of subclavian artery disease.
Main Methods:
- Prospective analysis of 1914 VA Doppler waveforms.
- Identification of 40 waveforms with mid-late systolic velocity decline.
- Application of reactive hyperemia test and correlation with angiography in 20 cases.
Main Results:
- Four prototypic VA waveform types were identified based on systolic deceleration.
- The reactive hyperemia test altered waveforms in 36 of 40 affected patients.
- A statistically significant correlation (p=0.03) was found between waveform type and subclavian disease.
Conclusions:
- Antegrade VA waveform pulse contour changes indicate early SSS.
- Classifiable waveform types reflect progressive hemodynamic abnormalities.
- Doppler waveform analysis is a valuable tool for diagnosing early-stage SSS.