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Transcranial Doppler Ultrasonography of the Middle Cerebral Artery in the Hemodynamic Assessment of Internal Carotid Artery Stenosis

Transcranial Doppler Ultrasonography of the Middle Cerebral Artery in the Hemodynamic Assessment... Abstract • We performed transcranial Doppler ultrasonography of the middle cerebral arteries in 43 patients who underwent cerebral angiography. Twelve patients had normal arteriograms, 18 had internal carotid artery stenosis, and 13 had complete occlusion. Parameters measured included: flow velocity (mean, maximum, and peak systolic), flow acceleration, systolic-to-diastolic ratio, and pulsatility index. Patients with 75% to 100% stenosis had lower average ipsilateral flow acceleration and mean velocity than did normal subjects. Correlation analysis revealed an inverse relationship between degree of stenosis and ipsilateral flow acceleration, as well as ipsilateral mean velocity. These correlations were no longer significant when we excluded normals, however. There was a linear relationship between right and left velocity values for both normal subjects and patients with occlusion but not for patients with stenosis. This technique has potential for the reliable assessment of the hemodynamic effect of carotid stenosis on intracranial circulation. References 1. Bishop CCR, Powell S, Rutt D, Browse NL. Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study . Stroke . 1986;17:913-915.Crossref 2. Lindegaard K-F, Bakke SJ, Grolimund P, et al. Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound . J Neurosurg . 1985;63:890-898.Crossref 3. Schneider PA, Rossman ME, Bernstein EF, et al. Effect of internal carotid artery occlusion on intracranial hemodynamics: transcranial Doppler evaluation and clinical correlation . Stroke . 1988;19:589-593.Crossref 4. Aaslid R. The Doppler principle applied to measurement of blood flow velocity in cerebral arteries . In: Aaslid R, ed. Transcranial Doppler Ultrasonography . New York, NY: Springer-Verlag NY Inc; 1986:23-38. 5. Gosling RG, King DH. Arterial assessment by Doppler ultrasound . Proc R Soc Med . 1974;67:447-449. 6. Harders A. Neurosurgical Applications of Transcranial Doppler Ultrasonography . New York, NY: Springer-Verlag NY Inc; 1986:7. 7. Aaslid R, Markwalder Th-M, Nornes H. Non-invasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries . J Neurosurg . 1982;57:769-774.Crossref 8. Aaslid R, Lindegaard K-F. Cerebral hemodynamics . In: Aaslid R, ed. Transcranial Doppler Ultrasonography . New York, NY: Springer-Verlag NY Inc; 1986:80. 9. Wiebers DO, Folger N, Forbes GS, et al. Ophthalmodynamometry and ocular plethysmography for detection of carotid occlusive disease . Arch Neurol . 1982;39:690-691.Crossref 10. Archie JP, Feldtman RW. Critical stenosis of the internal carotid artery . Surgery . 1984;89:67-72. 11. Bishop CCR, Powell S, Insall M, et al. Effect of internal carotid artery occlusion on middle cerebral artery blood flow at rest and in response to hypercapnia . Lancet . 1986;1:710-712.Crossref 12. Roscoe JT. The t test for two related samples . In: Fundamental Research Statistics for the Behavioral Sciences . New York, NY: Holt Rinehart & Winston; 1969:170-174. 13. Edwards AL. The correlation coefficient . In: Statistical Analysis . New York, NY: Holt Rinehart & Winston; 1974:70-89. 14. McDonald D. The nature of flow in a liquid . In: McDonald R, ed. Blood Flow in Arteries . London, England: Edward Arnold Ltd; 1960:11. 15. Young DF, Tsai FY. Flow characteristics in models of arterial stenoses, I: steady flow . J Biomech . 1973;6:395-410.Crossref 16. Fei D-Y, Billian C, Rittgers S. Flow dynamics in a stenosed carotid bifurcation model, I: basic velocity measurements . Ultrasound Med Biol . 1988;14:21-31.Crossref 17. Aaslid R. Transcranial Doppler examination techniques . In: Aaslid R, ed: Transcranial Doppler Ultrasonography . New York, NY: Springer-Verlag NY Inc; 1986:56-57. 18. Spencer MP. Blood flow arteries . In: Spencer MP, Reid JM. Cerebrovascular Evaluation With Doppler Ultrasound . Hingham, Mass: Martinus Nijhoff Publishers; 1981:97-112. 19. Arnolds BJ, von Reutern G-M. Transcranial Dopplersonography: examination techniques and normal reference values . Ultrasound Med Biol . 1986;12:155-123.Crossref 20. Ackerman RH. A perspective on noninvasive diagnosis of carotid artery disease . Neurology . 1979;29:615-622.Crossref 21. McDonald PT, Rich NM, Collins JG Jr, et al. Ocular pneumoplethysmography: detection of carotid occlusive disease . Ann Surg . 1979;189:44-48.Crossref 22. Ginsberg MD, Greenwood SA, Goldberg HI. Noninvasive diagnosis of extracranial cerebrovascular disease: oculoplethysmography-phonoangiography and directional Doppler ultra-sonography . Neurology . 1979;29:623-631.Crossref 23. Mattle H, Grolimund P, Huber P, et al. Transcranial Doppler sonographic findings in middle cerebral artery disease . Arch Neurol . 1988;45:289-295.Crossref 24. Lindegaard K-F, Bakke SJ, Aaslid R, Nornes H. Doppler diagnosis of intracranial artery occlusive disorders . J Neurol Neurosurg Psychiatry . 1986;49:510-518.Crossref 25. Wechsler LR, Ropper AH, Kistler JP Transcranial Doppler in cerebrovascular disease . Stroke . 1986;17:905-912.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

Transcranial Doppler Ultrasonography of the Middle Cerebral Artery in the Hemodynamic Assessment of Internal Carotid Artery Stenosis

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Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-9942
eISSN
1538-3687
DOI
10.1001/archneur.1990.00530090030009
Publisher site
See Article on Publisher Site

Abstract

Abstract • We performed transcranial Doppler ultrasonography of the middle cerebral arteries in 43 patients who underwent cerebral angiography. Twelve patients had normal arteriograms, 18 had internal carotid artery stenosis, and 13 had complete occlusion. Parameters measured included: flow velocity (mean, maximum, and peak systolic), flow acceleration, systolic-to-diastolic ratio, and pulsatility index. Patients with 75% to 100% stenosis had lower average ipsilateral flow acceleration and mean velocity than did normal subjects. Correlation analysis revealed an inverse relationship between degree of stenosis and ipsilateral flow acceleration, as well as ipsilateral mean velocity. These correlations were no longer significant when we excluded normals, however. There was a linear relationship between right and left velocity values for both normal subjects and patients with occlusion but not for patients with stenosis. This technique has potential for the reliable assessment of the hemodynamic effect of carotid stenosis on intracranial circulation. References 1. Bishop CCR, Powell S, Rutt D, Browse NL. Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study . Stroke . 1986;17:913-915.Crossref 2. Lindegaard K-F, Bakke SJ, Grolimund P, et al. Assessment of intracranial hemodynamics in carotid artery disease by transcranial Doppler ultrasound . J Neurosurg . 1985;63:890-898.Crossref 3. Schneider PA, Rossman ME, Bernstein EF, et al. Effect of internal carotid artery occlusion on intracranial hemodynamics: transcranial Doppler evaluation and clinical correlation . Stroke . 1988;19:589-593.Crossref 4. Aaslid R. The Doppler principle applied to measurement of blood flow velocity in cerebral arteries . In: Aaslid R, ed. Transcranial Doppler Ultrasonography . New York, NY: Springer-Verlag NY Inc; 1986:23-38. 5. Gosling RG, King DH. Arterial assessment by Doppler ultrasound . Proc R Soc Med . 1974;67:447-449. 6. Harders A. Neurosurgical Applications of Transcranial Doppler Ultrasonography . New York, NY: Springer-Verlag NY Inc; 1986:7. 7. Aaslid R, Markwalder Th-M, Nornes H. Non-invasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries . J Neurosurg . 1982;57:769-774.Crossref 8. Aaslid R, Lindegaard K-F. Cerebral hemodynamics . In: Aaslid R, ed. Transcranial Doppler Ultrasonography . New York, NY: Springer-Verlag NY Inc; 1986:80. 9. Wiebers DO, Folger N, Forbes GS, et al. Ophthalmodynamometry and ocular plethysmography for detection of carotid occlusive disease . Arch Neurol . 1982;39:690-691.Crossref 10. Archie JP, Feldtman RW. Critical stenosis of the internal carotid artery . Surgery . 1984;89:67-72. 11. Bishop CCR, Powell S, Insall M, et al. Effect of internal carotid artery occlusion on middle cerebral artery blood flow at rest and in response to hypercapnia . Lancet . 1986;1:710-712.Crossref 12. Roscoe JT. The t test for two related samples . In: Fundamental Research Statistics for the Behavioral Sciences . New York, NY: Holt Rinehart & Winston; 1969:170-174. 13. Edwards AL. The correlation coefficient . In: Statistical Analysis . New York, NY: Holt Rinehart & Winston; 1974:70-89. 14. McDonald D. The nature of flow in a liquid . In: McDonald R, ed. Blood Flow in Arteries . London, England: Edward Arnold Ltd; 1960:11. 15. Young DF, Tsai FY. Flow characteristics in models of arterial stenoses, I: steady flow . J Biomech . 1973;6:395-410.Crossref 16. Fei D-Y, Billian C, Rittgers S. Flow dynamics in a stenosed carotid bifurcation model, I: basic velocity measurements . Ultrasound Med Biol . 1988;14:21-31.Crossref 17. Aaslid R. Transcranial Doppler examination techniques . In: Aaslid R, ed: Transcranial Doppler Ultrasonography . New York, NY: Springer-Verlag NY Inc; 1986:56-57. 18. Spencer MP. Blood flow arteries . In: Spencer MP, Reid JM. Cerebrovascular Evaluation With Doppler Ultrasound . Hingham, Mass: Martinus Nijhoff Publishers; 1981:97-112. 19. Arnolds BJ, von Reutern G-M. Transcranial Dopplersonography: examination techniques and normal reference values . Ultrasound Med Biol . 1986;12:155-123.Crossref 20. Ackerman RH. A perspective on noninvasive diagnosis of carotid artery disease . Neurology . 1979;29:615-622.Crossref 21. McDonald PT, Rich NM, Collins JG Jr, et al. Ocular pneumoplethysmography: detection of carotid occlusive disease . Ann Surg . 1979;189:44-48.Crossref 22. Ginsberg MD, Greenwood SA, Goldberg HI. Noninvasive diagnosis of extracranial cerebrovascular disease: oculoplethysmography-phonoangiography and directional Doppler ultra-sonography . Neurology . 1979;29:623-631.Crossref 23. Mattle H, Grolimund P, Huber P, et al. Transcranial Doppler sonographic findings in middle cerebral artery disease . Arch Neurol . 1988;45:289-295.Crossref 24. Lindegaard K-F, Bakke SJ, Aaslid R, Nornes H. Doppler diagnosis of intracranial artery occlusive disorders . J Neurol Neurosurg Psychiatry . 1986;49:510-518.Crossref 25. Wechsler LR, Ropper AH, Kistler JP Transcranial Doppler in cerebrovascular disease . Stroke . 1986;17:905-912.Crossref

Journal

Archives of NeurologyAmerican Medical Association

Published: Sep 1, 1990

References

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