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Symptomatic and asymptomatic high-grade carotid stenoses in Doppler color-flow imaging
W Steinke1, M Hennerici, W Rautenberg
1Neurological Institute, Columbia Presbyterian Medical Center, New York, NY.
Insights
Doppler color-flow imaging (DCFI) reveals distinct plaque features in symptomatic versus asymptomatic carotid stenosis. However, DCFI did not identify specific hemodynamic patterns differentiating symptomatic from asymptomatic high-grade carotid stenoses.
Area of Science:
- Vascular Ultrasound
- Cerebrovascular Imaging
- Medical Diagnostics
Background:
- Carotid stenosis is a significant risk factor for stroke.
- Accurate differentiation between symptomatic and asymptomatic stenosis is crucial for patient management.
- Doppler color-flow imaging (DCFI) is an advanced ultrasound technique for evaluating carotid arteries.
Purpose of the Study:
- To evaluate the utility of Doppler color-flow imaging (DCFI) in differentiating symptomatic from asymptomatic high-grade carotid stenoses.
- To compare plaque surface morphology and hemodynamic patterns identified by DCFI with clinical presentation.
- To assess the correlation between DCFI findings and conventional angiography.
Main Methods:
- Sixty-three patients with high-grade carotid stenosis (≥80%) were examined using DCFI.
- Plaque surface morphology (ulcerated, calcific, echolucent) and hemodynamic patterns were analyzed.
- DCFI results were compared with clinical symptoms and 30 conventional angiograms.
Main Results:
- Symptomatic stenoses showed a higher frequency of ulcerated plaques (43% vs. 23%) and echolucent plaques (29% vs. 11%) compared to asymptomatic ones.
- Calcific lesions were more frequent in asymptomatic stenoses (46% vs. 29%).
- No significant differences in color-coded hemodynamic patterns were observed between symptomatic and asymptomatic groups. DCFI showed good agreement with angiography for plaque surface analysis (70%) and area reduction (85%) but tended to underestimate diameter reduction.
Conclusions:
- DCFI can identify distinct morphologic features of carotid plaques, such as ulceration and echolucency, which may help differentiate symptomatic from asymptomatic high-grade stenoses.
- However, DCFI did not reveal specific hemodynamic patterns that distinguish symptomatic from asymptomatic carotid stenoses.
- The findings suggest that plaque morphology, rather than hemodynamic patterns, is a key differentiator detectable by advanced ultrasound techniques.
Abstract:
We examined 63 patients with 31 symptomatic and 44 asymptomatic carotid stenoses with Doppler color-flow imaging (DCFI); conventional Doppler duplex had shown a hemodynamic obstruction (greater than or equal to 80% stenosis) in all patients. Analysis of plaque surface morphology demonstrated more ulcerated plaques in symptomatic (43%) than asymptomatic (23%) stenoses. Although the frequency of homogeneous and heterogeneous plaques was not different, calcific lesions were more frequent in asymptomatic (46% versus 29%), and echolucent plaques, probably indicating mural thrombi, were more frequent in symptomatic (29% versus 11%) stenosis. Color-coded hemodynamic patterns, such as jet flow, poststenotic turbulence, or reversed flow, were not different in symptomatic and asymptomatic stenoses. Comparison of DCFI with 30 angiograms showed agreement in plaque surface analysis in 70%. DCFI measurements of area reduction in cross sections correlated with angiography in 85%, while DCFI tended to underestimate the degree of stenosis from diameter reduction in longitudinal cuts. The advanced DCFI technique identified distinct morphologic features but no hemodynamic patterns, separating symptomatic from asymptomatic high-grade carotid stenoses.