Johansson Elias, Benhabib Hadas, Herod Wendy, Hopyan Julia, Machnowska Matylda, Maggisano Robert, Aviv Richard, Fox Allan J
1 Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.
2 Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
Acta Radiol. 2019 Mar;60(3):396-404. doi: 10.1177/0284185118780900. Epub 2018 Jun 13.
Most carotid near-occlusions are indistinguishable from conventional ≥ 50% stenosis on ultrasound, demonstrating high peak systolic velocity (PSV) in the stenosis.
To study whether the velocity distal to the stenosis can separate high PSV near-occlusion from conventional ≥ 50% stenosis.
We included patients with ≥ 50% carotid stenosis with high PSV (≥125 cm/s), examined with both computed tomography angiography (CTA) and ultrasound within 30 days, and a distal velocity measurement was performed. Based on CTA, cases were divided into three groups: conventional stenosis; near-occlusion without full collapse (NwoC; normal-appearing albeit small distal artery); and near-occlusion with full collapse (NwC; threadlike distal artery). Distal Doppler ultrasound flow velocities were compared between these groups.
Sixty patients were included: 33 patients with conventional stenosis; 20 patients with NwoC; and seven patients with NwC. Mean distal PSV was 93, 63, and 21 cm/s ( P < 0.001) and mean distal end-diastolic velocity was 30, 24, and 5 cm/s ( P < 0.001), respectively. A distal PSV < 50 cm/s was 63% sensitive and 94% specific for separating both types of near-occlusion from conventional stenosis.
In high PSV carotid stenoses, the distal velocity was lower in near-occlusions than conventional carotid stenosis. Distal velocities warrant further investigation in diagnostic studies.
