Abstract

Gradation of high-grade intracranial internal carotid artery (ICA) stenosis poses a challenge to noninvasive neurovascular imaging, which seems critical for angioplasty in the ICA segments C1 and C5. We investigated cutoff values of intracranial ICA stenosis for transcranial color-coded sonography (TCCS) and compared this method with the "gold standard," digital subtraction angiography (DSA). Forty patients (mean age, 58.9 +/- 13.8 years) with intracranial ICA lesions were prospectively examined by using TCCS and DSA. Two standard TCCS coronal imaging planes were used to evaluate the intracranial ICA. In addition, a control group of 128 volunteers without cerebrovascular disease (mean age, 48.8 +/- 15.9 years) was investigated to establish standard velocity values. DSA confirmed 96 stenoses and 8 occlusions of the intracranial ICA in the study population. In 9% and 7% of cases, stenosis confined to the C1 or C5 segment was >50% and 70%, respectively. Receiver-operating curves demonstrated cutoff values for >70% stenosis in C1 when the peak systolic velocity (PSV) was >200 cm/s (specificity, 100%; sensitivity, 71%) or the C1/submandibular ICA index was >3 (specificity, 93%; sensitivity, 86%). TCCS is a reliable adjunctive method to detect and quantify significant stenosis of the intracranial ICA. The assessment of the C1/ICA index and peak systolic velocities maximizes the diagnostic accuracy of C1 stenosis to >70% when extracranial ICA stenosis coexists. Further studies need to be performed to compare the diagnostic accuracies of MR angiography and TCCS with that of DSA.

Highlights

  • ObjectivesThe aim of this study was to elaborate the transcranial color-coded sonography (TCCS) criteria for detection and quantification of significant intracranial internal carotid artery (ICA) stenosis and to correlate them with conventional digital subtraction angiography (DSA) criteria as the standard of reference

  • AND PURPOSE: Gradation of high-grade intracranial internal carotid artery (ICA) stenosis poses a challenge to noninvasive neurovascular imaging, which seems critical for angioplasty in the ICA segments C1 and C5

  • The assessment of the C1/ICA index and peak systolic velocities maximizes the diagnostic accuracy of C1 stenosis to Ͼ70% when extracranial ICA stenosis coexists

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Summary

Objectives

The aim of this study was to elaborate the TCCS criteria for detection and quantification of significant intracranial ICA stenosis and to correlate them with conventional DSA criteria as the standard of reference

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