Distinguishing carotid artery pseudo-occlusion with color-flow Doppler

• Published in: Stroke (1970) 1995-03, Vol.26 (3), p.434-438
• Main Authors: BERMAN, S. S, DEVINE, J. J, ERDOES, L. S, HUNTER, G. C
• Format: Article
• Language: English
• Subjects: Acute Disease; Angiography, Digital Subtraction; Arterial Occlusive Diseases - diagnostic imaging; Arterial Occlusive Diseases - pathology; Biological and medical sciences; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - pathology; Carotid Artery Thrombosis - diagnostic imaging; Carotid Artery Thrombosis - pathology; Carotid Artery, Common - diagnostic imaging; Carotid Artery, Common - pathology; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - pathology; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - pathology; Cerebrovascular Disorders - surgery; Diagnosis, Differential; Endarterectomy, Carotid; Humans; Ischemic Attack, Transient - surgery; Medical sciences; Neurology; Recurrence; Regional Blood Flow - physiology; Retrospective Studies; Ultrasonography, Doppler, Color; Vascular diseases and vascular malformations of the nervous system; Vascular Patency; Vascular Resistance - physiology
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.26.3.434

This study was undertaken to determine the impact of color-flow Doppler on the accuracy of noninvasive carotid imaging for distinguishing an internal carotid artery pseudo-occlusion (string sign) from a complete occlusion. From January 1985 to January 1994, review of noninvasive vascular studies, arteriograms, and operative reports of 26 consecutive patients undergoing 27 carotid endarterectomies for carotid pseudo-occlusion was performed. Further review was conducted of all patients identified with carotid occlusion by noninvasive testing who underwent confirmatory arteriography during the same interval. Conventional gray-scale duplex scanning (January 1985 to December 1989) correctly identified 3 of 11 (27%) pseudo-occluded internal carotid arteries compared with 15 of 16 (94%) internal carotid artery pseudo-occlusions correctly identified by color-flow Doppler (January 1990 to June 1994) (P < .01). Similarly, carotid occlusion was more accurately identified by color-flow Doppler (33 of 33, 100%) compared with gray-scale duplex scanning (19 of 27, 90%) (P < .01). The addition of color-flow Doppler to the duplex evaluation of the extracranial carotid circulation improves the accuracy of distinguishing carotid pseudo-occlusion from the occluded internal carotid artery and may obviate the need for arteriography to identify patients with this critical level of carotid stenosis.