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Velocity Criteria for Intracranial Stenosis Revisited: An International Multicenter Study of Transcranial Doppler and Digital Subtraction Angiography.
MedLine Citation:
PMID:  21960567     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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 Intracranial Atherosclerosis (SONIA) criteria were used for identification of ≥50% stenosis. We determined velocity cutoffs for ≥70% stenosis on digital subtraction 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 subtraction angiography, ≥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.
Authors:
Limin Zhao; Kristian Barlinn; Vijay K Sharma; Georgios Tsivgoulis; Luis F Cava; Spyros N Vasdekis; Hock Luen Teoh; Nikos Triantafyllou; Bernard P L Chan; Arvind Sharma; Konstantinos Voumvourakis; Elefterios Stamboulis; Maher Saqqur; Mark R Harrigan; Karen C Albright; Andrei V Alexandrov
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-9-29
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  -     ISSN:  1524-4628     ISO Abbreviation:  -     Publication Date:  2011 Sep 
Date Detail:
Created Date:  2011-9-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Comprehensive Stroke Center, University of Alabama at Birmingham Hospital, Birmingham, AL; Dresden University Stroke Center, Department of Neurology, University of Technology, Dresden, Germany; the Division of Neurology, Department of Medicine, National University Hospital, Singapore; the Department of Neurology, Democritus University of Thrace, School of Medicine, Alexandroupolis, Greece; the Second Department of Neurology, University of Athens, School of Medicine, Athens, Greece; the Third Surgical Department, Vascular Unit, University of Athens, School of Medicine, Athens, Greece; the First Department of Neurology, University of Athens, School of Medicine, Athens, Greece; the Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and the Division of Neurosurgery, University of Alabama at Birmingham Hospital, Birmingham, AL.
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