Baumgartner R W, Mattle H P, Schroth G
Department of Neurology, University Hospital of Zürich, Switzerland.
Stroke. 1999 Jan;30(1):87-92. doi: 10.1161/01.str.30.1.87.
A favorable risk-benefit ratio for warfarin compared with aspirin has been reported for the prevention of major vascular events in symptomatic >/=50% intracranial stenoses. Transcranial color-coded duplex sonography (TCCS) criteria providing an accurate detection of >/=50% and <50% stenoses of the anterior, middle, and posterior cerebral arteries and basilar and vertebral arteries were evaluated retrospectively with angiography used as the standard of reference.
Prospectively collected TCCS, extracranial color-coded duplex sonography, and intra-arterial digital subtraction angiography data of 310 patients were reviewed. The patients had angiography for confirmation of symptomatic extracranial >/=70% carotid stenoses, symptomatic stenoses (peak systolic velocity higher than the corresponding mean value +2 SDs of 104 normal subjects), and occlusions of the middle cerebral or basilar artery previously assessed by ultrasound. The sonographer was not aware of angiographic findings.
TCCS would have detected all 31 of >/=50% intracranial stenoses with 1 false-positive and 35 of 38 <50% stenoses with 3 false-positives. One of 69 stenoses (1%) and 280 of 2741 normal arteries (10%) were missed because of inadequate insonation windows. The corresponding peak systolic velocity cutoffs for >/=50%/<50% stenoses were >/=155/>/=120 cm/s (anterior cerebral artery), >/=220/>/=155 cm/s (middle cerebral artery), >/=145/>/=100 cm/s (posterior cerebral artery), >/=140/>/=100 cm/s (basilar artery), and >/=120/>/=90 cm/s (vertebral artery).
TCCS may reliably assess >/=50% and <50% basal cerebral artery narrowing and prove useful for noninvasive management of patients with symptomatic intracranial stenoses.
对于有症状的颅内狭窄≥50%患者，华法林预防主要血管事件的风险效益比优于阿司匹林。以血管造影作为参考标准，回顾性评估经颅彩色编码双功能超声（TCCS）对大脑前、中、后动脉以及基底动脉和椎动脉≥50%和<50%狭窄的准确检测标准。
回顾性分析前瞻性收集的310例患者的TCCS、颅外彩色编码双功能超声及动脉内数字减影血管造影数据。这些患者因有症状的颅外≥70%颈动脉狭窄、有症状的狭窄（收缩期峰值速度高于104名正常受试者相应平均值+2个标准差）以及先前超声评估的大脑中动脉或基底动脉闭塞而行血管造影以确诊。超声检查者不知晓血管造影结果。
TCCS能检测出所有31例≥50%的颅内狭窄，假阳性1例；能检测出38例<50%狭窄中的35例，假阳性3例。因声窗不佳，69例狭窄中的1例（1%）及2741条正常动脉中的280条（10%）漏诊。≥50%/<50%狭窄对应的收缩期峰值速度截断值分别为：大脑前动脉≥155/≥120 cm/s，大脑中动脉≥220/≥155 cm/s，大脑后动脉≥145/≥100 cm/s，基底动脉≥140/≥100 cm/s，椎动脉≥120/≥90 cm/s。
TCCS可可靠地评估基底脑动脉≥50%和<50%的狭窄情况，对于有症状的颅内狭窄患者的无创管理可能有用。
