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Carotid near-occlusion can be identified with ultrasound by low flow velocity distal to the stenosis
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.ORCID iD: 0000-0001-5317-4563
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2019 (English)In: Acta Radiologica, ISSN 0284-1851, E-ISSN 1600-0455, Vol. 60, no 3, p. 396-404Article in journal (Refereed) Published
Abstract [en]

Background: Most carotid near-occlusions are indistinguishable from conventional >= 50% stenosis on ultrasound, demonstrating high peak systolic velocity (PSV) in the stenosis. Purpose To study whether the velocity distal to the stenosis can separate high PSV near-occlusion from conventional >= 50% stenosis.

Material and Methods: We included patients with >= 50% carotid stenosis with high PSV (>= 125 cm/s), examined with both computed tomography angiography (CTA) and ultrasound within 30 days, and a distal velocity measurement was performed. Based on CTA, cases were divided into three groups: conventional stenosis; near-occlusion without full collapse (NwoC; normal-appearing albeit small distal artery); and near-occlusion with full collapse (NwC; threadlike distal artery). Distal Doppler ultrasound flow velocities were compared between these groups.

Results: Sixty patients were included: 33 patients with conventional stenosis; 20 patients with NwoC; and seven patients with NwC. Mean distal PSV was 93, 63, and 21 cm/s (P < 0.001) and mean distal end-diastolic velocity was 30, 24, and 5 cm/s (P < 0.001), respectively. A distal PSV < 50 cm/s was 63% sensitive and 94% specific for separating both types of near-occlusion from conventional stenosis.

Conclusion: In high PSV carotid stenoses, the distal velocity was lower in near-occlusions than conventional carotid stenosis. Distal velocities warrant further investigation in diagnostic studies.

Place, publisher, year, edition, pages
Sage Publications, 2019. Vol. 60, no 3, p. 396-404
Keywords [en]
Stroke, carotid stenosis, near-occlusion, CT angiography, ultrasound, distal velocity
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:umu:diva-157204DOI: 10.1177/0284185118780900ISI: 000458887800016PubMedID: 29896980OAI: oai:DiVA.org:umu-157204DiVA, id: diva2:1303113
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-11-19Bibliographically approved

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