Abstract
BackgroundStroke is a common cause of morbidity and mortality around the world. Intracranial large artery atherosclerosis (ICAD) is a frequent etiology of stroke in the South Asian population. There is a need for widely available screening tools to identify patients that are at high risk of stroke due to ICAD for aggressive risk management. This study describes the experience of using the transcranial Doppler (TCD) as a screening tool for this purpose at a tertiary care hospital in a developing country.Methods86 Patients admitted with stroke due to ICAD underwent TCD for six arteries (Right and left middle cerebral arteries, right and left anterior cerebral arteries, right and left posterior cerebral arteries) in addition to the magnetic resonance angiography (MRA) that is done routinely at the stroke center. Arteries were labeled with either <50 or >50% stenosis by TCD using two separate criteria. These findings were compared with those from the MRA which was used as the gold standard. The proportion of patients that had complete exams (all six arteries insonated by TCD) was reported. The success rate of each TCD criteria in detecting arteries with >50% stenosis was also calculated.ResultsThere was an attempt to visualize 516 arteries (86 patients with 6 arteries each) of which 375 (72.7%) were successfully insonated. 38 of the 86 (55.8%) patients had complete examinations. MRA reported 43 (8.3%) arteries as stenosed >50%. The TCD did not categorize any artery as stenosed using either criterion and hence failed to classify any stenosed artery correctly. The positive predictive and sensitivity was 0 for this study and the negative predictive value was 93.3%.ConclusionsThis study indicates the poor sensitivity of TCD to be a reliable screening tool for the presence of ICAD in the South Asian population in a real life clinical setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1289-3) contains supplementary material, which is available to authorized users.
Highlights
Stroke is a common cause of morbidity and mortality around the world
Participants had to consent to transcranial Doppler (TCD) in addition to routine magnetic resonance angiography (MRA) which is done as part of standard of care of every patient admitted with stroke at this center
Among the 86 patients enrolled in the study, all 6 arteries (LACA, right anterior cerebral artery (RACA), left middle cerebral artery (LMCA), right middle cerebral artery (RMCA), left posterior cerebral artery (LPCA), right posterior cerebral artery (RPCA)) were found normal in 55 (63.9%) of the patients as detected by the MRA while the remaining 31 patients had at least one diseased artery
Summary
Stroke is a common cause of morbidity and mortality around the world. Intracranial large artery atherosclerosis (ICAD) is a frequent etiology of stroke in the South Asian population. The pathophysiology of ischemic stroke revolves around atherosclerotic plaque formation over a number of years in the arteries of the Circle of Willis before the final cerebrovascular event. This event is presumably caused by a rupture of that plaque or progressive hemodynamic stenosis leading to decompensated low flow state with failure of the collaterals [9, 10]. Regardless of the mechanism of stroke, prevention is the key to reduce mortality [11] Studies such as WASID study [12] have identified medications that are beneficial in high risk patients. To identify intracranial stenosis there need to be screening tools that are effective and widely available at an affordable cost to make them relevant to low income countries where this condition is prevalent
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