Carotid near-occlusion can be identified with ultrasound by low flow velocity distal to the stenosis

Background: Most carotid near-occlusions are indistinguishable from conventional >= 50% stenosis on ultrasound, demonstrating high peak systolic velocity (PSV) in the stenosis. Purpose To study whether the velocity distal to the stenosis can separate high PSV near-occlusion from conventional >= 50% stenosis.Material and Methods: 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.Results: 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.Conclusion: 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.

Av författaren/redakt...: Johansson, Elias; Benhabib, Hadas; Herod, Wendy; Hopyan, Julia; Machnowska, Maty ...; Maggisano, Rober ...; visa fler...; Aviv, Richard; Fox, Allan J.; visa färre...

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