Velocity Criteria for Intracranial Stenosis Revisited An International Multicenter Study of Transcranial Doppler and Digital Subtraction Angiography

Abstract

BACKGROUND AND PURPOSE:

Intracranial atherosclerotic disease is associated with a high risk of stroke recurrence. We aimed to determine accuracy of transcranial Doppler screening at laboratories that share the same standardized scanning protocol.

METHODS:

Patients with symptoms of cerebral ischemia were prospectively studied. Stroke Outcomes and Neuroimaging of IntracranialAtherosclerosis (SONIA) criteria were used for identification of ≥50% stenosis. We determined velocity cutoffs for ≥70% stenosis on digitalsubtraction angiography by Warfarin-Aspirin Symptomatic Intracranial Disease criteria and evaluated novel stenotic/prestenotic ratio and low-velocity criteria.

RESULTS:

A total of 102 patients with intracranial atherosclerotic disease (age 57±13 years; 72% men; median National Institutes of Health Stroke Scale 3, interquartile range 6) provided 690 transcranial Doppler/digital subtraction angiography vessel pairs. On digital subtractionangiography, ≥50% stenosis was found in 97 and ≥70% stenosis in 62 arteries. Predictive values for transcranial Doppler SONIA criteria were similar (P>0.9) between middle cerebral artery (sensitivity 78%, specificity 93%, positive predictive value 73%, negative predictive value 94%, and overall accuracy 90%) and vertebral artery/basilar artery (69%, 98%, 88%, 93%, and 92%). As a single velocity criterion, most sensitive mean flow velocity thresholds for ≥70% stenosis were: middle cerebral artery>120 cm/s (71%) and vertebral artery/basilar artery>110 cm/s (55%). Optimal combined criteria for ≥70% stenosis were: middle cerebral artery>120 cm/s, or stenotic/prestenotic ratio≥3, or low velocity(sensitivity 91%, specificity 80%, receiver operating characteristic 0.858), and vertebral artery/basilar artery>110 cm/s or stenotic/prestenotic ratio≥3 (60%, 95%, 0.769, respectively).

CONCLUSIONS:

At laboratories with a standardized scanning protocol, SONIA mean flow velocity criteria remain reliably predictive of ≥50% stenosis. Novel velocity/ratio criteria for ≥70% stenosis increased sensitivity and showed good agreement with invasive angiography.

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ARTIGO ESTABELECE CORRELAÇÃO  DE ESTENOSE INTRACRANIANA ENTRE O DOPPLER TRANSCRANIANO E A  ANGIOGRAFIA CEREBRAL EM PACIENTES PORTADORES DE AVCI, AIT.

VALORES DE ESTENOSE DOS ESTUDOS SONIA E SAMMPRIS FORAM REVISITADOS E ADICIONADOS  RAZÕES DE VELOCIDADES ENTRE OS SEGMENTOS PRÉ ESTENÓTICOS E ESTENÓTICOS AFIM DE MELHORAR A PREDIÇÃO.

EXCELENTE ARTIGO PARA APLICAÇÃO DIÁRIA NO CUIDADO DOS PACIENTES VÍTIMAS DE AVCI.