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Diagnosis of high-grade stenosis of innominate artery
F Verlato1, F Grego, G P Avruscio
1Angiology Department, Hospital of Padua, Italy.
Insights
This study introduces an indirect ultrasound method to evaluate innominate artery (IA) pathology by examining surrounding arteries. This technique aids in diagnosing IA stenosis and occlusion, improving patient outcomes through timely intervention.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Neurology
Background:
- Innominate artery (IA) pathology can significantly impair extracranial circulation and lead to cerebrovascular events.
- Current noninvasive methods like continuous-wave Doppler and duplex ultrasound struggle to reliably differentiate high-grade stenosis from occlusion of the IA.
Purpose of the Study:
- To propose and evaluate an indirect method for assessing IA pathology using echo-Doppler-color-flow (EDCF).
- To investigate the utility of EDCF in evaluating the carotid, subclavian, and vertebral arteries for signs of IA disease.
Main Methods:
- Utilized echo-Doppler-color-flow (EDCF) with 7.5 and 5 MHz linear-phase array probes.
- Studied 6 patients with confirmed IA pathology (2 occlusion, 1 stenosis 80%, 3 subocclusive stenosis >90%) over two years.
- Analyzed flow patterns in the carotid, subclavian, and vertebral arteries to infer IA condition.
Main Results:
- Innominate artery occlusion cases showed inverted right vertebral artery (VA) flow and involvement of the right common carotid (CC) artery.
- Subocclusive IA stenoses (>90%) demonstrated reduced systolic flow in the CC artery.
- 80% IA stenosis presented with inverted VA flow and reduced diastolic flow in the CC artery.
- Angiography confirmed all high-grade stenosis findings. Five patients underwent successful surgical correction.
Conclusions:
- An indirect EDCF method can reliably evaluate IA pathology by assessing adjacent vessels.
- This approach aids in differentiating stenosis from occlusion when direct methods are insufficient.
- Successful surgical interventions highlight the clinical significance of accurate IA diagnosis.
Abstract:
Although pathology of the innominate artery (IA) is not frequent, it causes relevant impairment of extracranial circulation and sometimes cerebrovascular events. Definite differentiation of high-grade stenosis from occlusion of the IA has not been obtained until now with continuous-wave (C.W.) Doppler and duplex system ultrasound, and thus the direct evaluation of IA is not reliable by noninvasive methods. In this study the authors suggest an indirect method of evaluation of IA pathology based on the study of carotid, subclavian, and vertebral arteries (VA) with echo-Doppler-color-flow (EDCF) (with linear--phase array probes of 7.5 and 5 MHz). In the last two years they studied 6 patients with IA pathology (2 with occlusion (occ), 1 with stenosis of 80% and 3 with subocclusive stenosis > 90%). In both patients with occ, right VA flow was inverted, and also the right common carotid (CC) was involved (occ in 1 case and inverted flow in the other); in the 3 subocclusive stenoses a lowered systolic flow in the CC was recorded (48 vs 85 cm/sec, 41 vs 77, and 23 vs 109). In the 80% stenosis, besides the inverted flow in VA, only a reduced diastolic flow in CC was also recorded (19 vs 33 cm/sec measured in the left side). All patients with high grade stenosis were successfully confirmed by an angiographic study, including the different degree of stenosis. Five of the 6 patients underwent surgical correction with a restored flow in the previously involved artery. Only 1 patient with occlusion is waiting for surgical correction.(ABSTRACT TRUNCATED AT 250 WORDS)