The Doppler Ultrasonic Cerebrovascular Examination: Improved Accuracy by Refinement of Technique

Abstract

Although strokes take the lives of more than 200,000 people annually, 25% of stroke prone patients have occlusive disease amenable to extracranial surgical techniques. Therefore, the diagnosis of extracranial carotid occlusive disease becomes an important priority in health care. One of the simplest, safest and most accurate techniques for evaluating extracranial occlusive vascular disease is the determination of directional flow in the supraorbital artery using the Doppler ultrasonic velocity detector. The 10 megahertz Doppler probe permits detection of flow in the supraorbital artery which is normally out of the orbit and augmented by compression of the ipsilateral temporal artery. In the presence of significant stenosis (>70%) or occlusion of the internal carotid artery, the flow may be reversed and ipsilateral temporal artery compression may diminish or obliterate flow in the supraorbital artery. This technique may detect significant internal carotid disease with 90% accuracy but is associated with both false positive and false negative results. The present study presents the improved results of a modified Doppler cerebrovascular examination of 50 patients who underwent cerebral angiography for suspected arterial occlusive disease.