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Duplex sonography in patients with hemispheric symptoms
1Department of Radiology, Duke University Medical Center, Durham, North Carolina 27710.
Insights
Most patients experiencing hemispheric neurologic symptoms lack significant carotid artery stenosis. Duplex Doppler sonography effectively identifies patients needing further evaluation for carotid stenosis, aiding in treatment decisions.
Area of Science:
- Vascular Neurology
- Diagnostic Imaging
- Cerebrovascular Disease
Background:
- Hemispheric neurologic symptoms often present without significant extracranial carotid artery stenosis.
- Accurate assessment of carotid artery stenosis is crucial for managing patients with transient ischemic attacks (TIA), cerebrovascular accidents (CVA), and amaurosis fugax (AF).
Purpose of the Study:
- To determine the frequency of operative carotid artery stenosis in patients presenting with hemispheric neurologic symptoms.
- To evaluate the utility of duplex Doppler sonography as a primary diagnostic tool for identifying significant carotid stenosis.
Main Methods:
- 154 patients with documented hemispheric events underwent duplex Doppler examinations of the extracranial carotid bifurcation.
- Patient subgroups included those with TIA (n=72), CVA (n=62), and AF (n=20).
- Intra-arterial digital subtraction angiography (IADSA) was performed in a subset of patients (n=35) for comparison.
Main Results:
- A majority of patients showed less than 50% stenosis: 69% in TIA, 52% in CVA, and 65% in AF.
- Duplex Doppler sonography demonstrated high agreement with IADSA in identifying stenoses greater than 50% (35/35 cases).
Conclusions:
- Operative carotid artery stenosis is infrequent in patients with hemispheric neurologic symptoms.
- Duplex Doppler sonography is a reliable triage procedure for identifying patients with significant carotid stenosis who may benefit from surgical intervention.
Abstract:
Many patients with hemispheric neurologic symptoms do not have operative stenoses of the extracranial carotid arteries. In order to assess the frequency of such atherosclerotic lesions, 154 patients with documented hemispheric events underwent duplex Doppler examinations of the extracranial carotid bifurcation to assess if operative stenosis (70% to 80% stenosis) was present. Seventy-two patients with transient ischemic attacks (TIA), 62 patients with cerebrovascular accidents (CVA), and 20 patients with amaurosis fugax (AF) were studied. Sixty-nine percent of patients with TIAs demonstrated a less than 50% stenosis, 52% of patients with CVAs demonstrated a less than 50% stenosis, and 65% of patients with AF demonstrated a less than 50% stenosis on duplex Doppler examination. Intra-arterial digital subtraction angiography (IADSA) was performed in 35 of 154 patients. In all of these 35 cases, ultrasound and angiographic studies agreed with respect to whether or not a greater than 50% stenosis was present. Our findings support the use of duplex Doppler sonography as a triage procedure in patients with hemispheric events in order to determine those patients who have significant carotid stenoses and who may be potential operative candidates.