Hemodynamic effects of innominate artery occlusive disease. Evaluation by Doppler ultrasound

Between 1976 and 1987 we saw 20 patients presenting with stenosis or occlusion of the innominate artery with a measurable hemodynamic effect. This corresponds to less than 0.1% of our patients subjected to noninvasive vascular testing. The hemodynamic sequelae involved the vertebral as well as the carotid arteries. The majority of the cases (n = 17) showed a vertebral steal and only minor concomitant alterations of carotid artery flow. Only three patients had a carotid steal in addition to the vertebral steal. In general, the vertebral steal is predominant over the carotid steal and precedes the latter. We propose a phenomenological classification of innominate artery disease following the severity of hemodynamic changes. Type I shows systolic deceleration or alternating flow in the right vertebral artery and only minor changes in the carotid arteries. Type II is characterized by reversed flow in the ipsilateral vertebral artery and systolic deceleration in the carotid arteries and type III by alternating flow or even complete steal in the carotid arteries in addition to vertebral artery steal. Continuous wave Doppler ultrasound is a valuable noninvasive method for examinating innominate artery occlusive disease and its hemodynamic sequelae. In special cases the additional use of duplex- and transcranial sonography is useful.