Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study

• Published in: Neuroradiology Vol. 63; no. 5; pp. 705 - 711
• Main Authors: Palacios-Mendoza, Michael Armando, García-Pastor, A., Gil-Núñez, A., Ramírez-Moreno, J. M., González-Nafría, N., Moniche, F., Portilla-Cuenca, J. C., Fuentes, B., Gamero-García, M. A., Alonso de Leciñana, M., Masjuan, J., Canovas-Verge, D., Aladro, Y., Lago, A., de Arce-Borda, A. M., Usero-Ruiz, M., Delgado-Mederos, R., Pampliega, A., Ximenez-Carrillo, Á., Bártulos-Iglesias, M., Castro-Reyes, E.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-05-2021; Springer Nature B.V
• Subjects: Angiography; Arteries; Cerebral blood flow; Communication; Diagnosis; Diagnostic Neuroradiology; Hemodynamics; Imaging; Ischemia; Medicine; Medicine & Public Health; Neurology; Neuroradiology; Neurosciences; Neurosurgery; Occlusion; Radiology; Stenosis; Ultrasonic imaging; Carotid stenosis; Collateral circulation; Cerebrovascular reactivity; Carotid near-occlusion; Hemodynamics; Ultrasonography
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s00234-020-02567-w

Purpose
The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO.
Methods
A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)–confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR).
Results
One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (
p
< 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s,
p
< 0.001; 0.80 vs 1.00,
p
< 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%,
p
= 0.051).
Conclusion
The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.