Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a mul
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DIAGNOSTIC NEURORADIOLOGY
Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study Michael Armando Palacios-Mendoza 1 & A. García Pastor 1 & A. Gil-Núñez 1 & J. M. Ramírez-Moreno 2 & N. González-Nafría 3 & F. Moniche 4 & J. C. Portilla-Cuenca 5 & B. Fuentes 6 & M. A. Gamero-García 7 & M. Alonso de Leciñana 8 & J. Masjuan 8 & D. Canovas Verge 9 & Y. Aladro 10 & A. Lago 11 & A. M. de Arce-Borda 12 & M. Usero-Ruiz 13 & R. Delgado-Mederos 14 & A. Pampliega 15 & Á. Ximenez-Carrillo 16 & M. Bártulos-Iglesias 17 & E. Castro-Reyes 1 & on behalf of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group Received: 8 June 2020 / Accepted: 23 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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. Keywords Carotid near-occlusion . Carotid stenosis . Ultrasonography . Hemodynamics . Collateral circulation . Cerebrovascular reactivity
* Michael Armando Palacios-Mendoza [email protected] 1
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Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007 Madrid, Spain Hospital Universitario Infanta Cristina, Neurology, Badajoz, Spain Complejo Asistencial Universitario de León, Neurology, Leon, Spain
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