Transcranial Doppler in asymptomatic carotid stenosis representing hemodynamic impairment: correlation study with
Dong Wook Kim1, Ju-Hong Min, Yong-Seok Lee
1Department of Neurology, Seoul Municipal Boramae Hospital, Korea.
Insights
Transcranial Doppler (TCD) can identify hemodynamic changes in asymptomatic carotid stenosis. These changes correlate with silent stroke indicators on MRI, aiding in surgical candidate selection.
Area of Science:
- Neurology
- Vascular Surgery
- Diagnostic Imaging
Background:
- Asymptomatic carotid stenosis poses a stroke risk, but endarterectomy benefits are less clear than for symptomatic cases.
- Improved patient selection for surgery requires better identification of high-risk individuals.
Purpose of the Study:
- To evaluate the role of transcranial Doppler (TCD) in assessing asymptomatic carotid stenosis.
- To determine the association between TCD-detected hemodynamic changes and MRI-identified abnormalities.
Main Methods:
- Retrospective analysis of 53 asymptomatic patients with >60% internal carotid artery stenosis.
- TCD hemodynamic changes were analyzed against demographic data, stroke risk factors, and MRI abnormalities.
Main Results:
- Patients with TCD hemodynamic changes showed a significantly higher proportion of stenosis-related MRI abnormalities (13/19 vs 6/34, P < .01).
- Odds ratio for MRI abnormality with hemodynamic change was 10.11 (95% CI: 2.73-37.4).
- No significant differences in demographics or stroke risk factors were observed between groups.
Conclusions:
- TCD-detected hemodynamic changes may indicate silent strokes in asymptomatic carotid stenosis.
- TCD offers valuable information for assessing stroke risk in these patients.
Background And Purpose:
Since the benefit of an endarterectomy in an asymptomatic carotid stenosis is not as clear as that in symptomatic stenosis, identifying patients with a high risk of stroke will allow the improved selection of surgical candidates. To evaluate the role of transcranial Doppler (TCD) in assessing an asymptomatic stenosis, this study examined the association of a TCD-detected hemodynamic change with a stenosis-related abnormality on magnetic resonance imaging (MRI).
Methods:
Asymptomatic patients with a more than 60% internal carotid artery stenosis were enrolled in this study. The hemodynamic change in the TCD was analyzed in terms of the demographic characteristics, the stroke risk factors, and the stenosis-related MRI abnormalities that are a proven risk factor of a further stroke.
Results:
Fifty-three patients were retrospectively recruited. While there were no differences in the demographic characteristics or frequency of the stroke risk factors, the proportion of patients with stenosis-related MRI abnormality was significantly higher in patients with a hemodynamic change on TCD (13/19 vs 6/34, P < .01; odds ratio = 10.11; 95% confidence interval = 2.73-37.4).
Conclusions:
The TCD-detected hemodynamic changes may provide useful information for assessing the frequency of silent stroke in patients with an asymptomatic carotid stenosis.
