Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study.

Autor: Palacios-Mendoza MA; Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain. michaelpalmend@gmail.com., García-Pastor A; Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain., Gil-Núñez A; Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain., Ramírez-Moreno JM; Hospital Universitario Infanta Cristina, Neurology, Badajoz, Spain., González-Nafría N; Complejo Asistencial Universitario de León, Neurology, Leon, Spain., Moniche F; Hospital Universitario Virgen del Rocío, Sevilla, Neurology, Sevilla, Spain., Portilla-Cuenca JC; Hospital San Pedro Alcántara, Neurology, Cáceres, Spain., Fuentes B; Hospital Universitario La Paz, Neurology, Madrid, Spain., Gamero-García MA; Hospital Universitario Virgen Macarena, Neurology, Sevilla, Spain., Alonso de Leciñana M; Hospital Universitario Ramón y Cajal, Neurology, Madrid, Spain., Masjuan J; Hospital Universitario Ramón y Cajal, Neurology, Madrid, Spain., Canovas-Verge D; Corporació Sanitaria Parc Taulí, Neurology, Sabadell, Spain., Aladro Y; Hospital Universitario de Getafe, Neurology, Getafe, Spain., Lago A; Hospital Universitari La Fe, Neurology, Valencia, Spain., de Arce-Borda AM; Hospital Universitario de Donostia, Neurology, Donostia, Spain., Usero-Ruiz M; Hospital Universitario de Valladolid, Neurology, Valladolid, Spain., Delgado-Mederos R; Hospital de la Santa Creu i Sant Pau, Neurology, Barcelona, Spain., Pampliega A; Hospital General Univeristario de Alicante, Neurology, Alicante, Spain., Ximenez-Carrillo Á; Hospital Universitario de La Princesa, Neurology, Madrid, Spain., Bártulos-Iglesias M; Hospital Universitario de Burgos, Neurology, Burgos, Spain., Castro-Reyes E; Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain.
Jazyk: angličtina
Zdroj: Neuroradiology [Neuroradiology] 2021 May; Vol. 63 (5), pp. 705-711. Date of Electronic Publication: 2020 Oct 06.
DOI: 10.1007/s00234-020-02567-w
Abstrakt: Purpose: The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO.
Methods: A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)-confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR).
Results: One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (p < 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s, p < 0.001; 0.80 vs 1.00, p < 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%, p = 0.051).
Conclusion: The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.
Databáze: MEDLINE
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