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. 1984 Apr;199(4):475–481. doi: 10.1097/00000658-198404000-00016

Correlation of hemodynamically significant internal carotid stenosis with pulsed Doppler frequency analysis.

W M Blackshear Jr, S L Lamb, V S Kollipara, J D Anderson, F R Murtagh, C P Shah, M S Farber
PMCID: PMC1353368  PMID: 6712324

Abstract

Systolic and mean pressure gradients across internal carotid stenoses were measured at the time of carotid endarterectomy in the arteries of 90 patients, all of whom underwent angiography. Eighty-two of these patients also had pulsed Doppler ultrasonic arteriography with real-time spectrum analysis. There were 71 (79%) high grade stenoses of greater than 50% diameter reduction by angiography. Significant systolic pressure gradients (greater than or equal to 10 mmHg) were identified in 41 patients (46%), 38 (46%) of whom underwent ultrasonic evaluation. A pulsed Doppler frequency measured within the stenosis equal to or greater than 6.5 kiloHertz had a sensitivity of 94.7% (36/38) in identifying pressure reducing lesions with a specificity of 47.7% (21/44). Positive predictive value was 61% (36/59). Angiographic criteria (50% diameter reduction) exhibited a sensitivity of 97.6% (40/41), a specificity of 36.7% (18/49) and a positive predictive value of 56.3% (40/71). Negative predictive value was 94.7% for angiography and 91.3% for ultrasonic arteriography. A pulsed Doppler frequency equal to or greater than 6.5 kiloHertz appears to accurately identify lesions that are at risk to reduce distal internal carotid pressure under operative conditions with a sensitivity similar to angiography. This criterion has a positive predictive value and specificity that is slightly superior to angiography and a high negative predictive value. Pulsed Doppler spectrum analysis provides physiologic information relative to blood flow velocity that is complimentary to the anatomic data provided by angiography for assessing the potential for hemodynamic significance of internal carotid stenoses.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Barnes R. W., Liebman P. R., Marszalek P. B., Kirk C. L., Goldman M. H. The natural history of asymptomatic carotid disease in patients undergoing cardiovascular surgery. Surgery. 1981 Dec;90(6):1075–1083. [PubMed] [Google Scholar]
  2. Berguer R., Hwang N. H. Critical arterial stenosis: a theoretical and experimental solution. Ann Surg. 1974 Jul;180(1):39–50. doi: 10.1097/00000658-197407000-00007. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blackshear W. M., Jr, Phillips D. J., Thiele B. L., Hirsch J. H., Chikos P. M., Marinelli M. R., Ward K. J., Strandness D. E., Jr Detection of carotid occlusive disease by ultrasonic imaging and pulsed Doppler spectrum analysis. Surgery. 1979 Nov;86(5):698–706. [PubMed] [Google Scholar]
  4. Busuttil R. W., Baker J. D., Davidson R. K., Machleder H. I. Carotid artery stenosis - hemodynamic significance and clinical course. JAMA. 1981 Apr 10;245(14):1438–1441. doi: 10.1001/jama.245.14.1438. [DOI] [PubMed] [Google Scholar]
  5. Carney W. I., Jr, Stewart W. B., DePinto D. J., Mucha S. J., Roberts B. Carotid bruit as a risk factor in aortoiliac reconstruction. Surgery. 1977 May;81(5):567–570. [PubMed] [Google Scholar]
  6. Evans W. E., Cooperman M. The significance of asymptomatic unilateral carotid bruits in preoperative patients. Surgery. 1978 May;83(5):521–522. [PubMed] [Google Scholar]
  7. Gee W., Mehigan J. T., Wylie E. J. Measurement of collateral cerebral hemispheric blood pressure by ocular pneumoplethysmography. Am J Surg. 1975 Aug;130(2):121–127. doi: 10.1016/0002-9610(75)90359-1. [DOI] [PubMed] [Google Scholar]
  8. Humphries A. W., Young J. R., Santilli P. H., Beven E. G., deWolfe V. G. Unoperated, asymptomatic significant internal carotid artery stenosis: a review of 182 instances. Surgery. 1976 Dec;80(6):695–698. [PubMed] [Google Scholar]
  9. Imparato A. M., Riles T. S., Mintzer R., Baumann F. G. The importance of hemorrhage in the relationship between gross morphologic characteristics and cerebral symptoms in 376 carotid artery plaques. Ann Surg. 1983 Feb;197(2):195–203. doi: 10.1097/00000658-198302000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Kartchner M. M., McRae L. P. Noninvasive evaluation and management of the "asymptomatic" carotid bruit. Surgery. 1977 Dec;82(6):840–847. [PubMed] [Google Scholar]
  11. MAY A. G., DE WEESE J. A., ROB C. G. Hemodynamic effects of arterial stenosis. Surgery. 1963 Apr;53:513–524. [PubMed] [Google Scholar]
  12. Moore W. S., Boren C., Malone J. M., Goldstone J. Asymptomatic carotid stenosis. Immediate and long-term results after prophylactic endarterectomy. Am J Surg. 1979 Aug;138(2):228–233. doi: 10.1016/0002-9610(79)90375-1. [DOI] [PubMed] [Google Scholar]
  13. Moore W. S., Boren C., Malone J. M., Roon A. J., Eisenberg R., Goldstone J., Mani R. Natural history of nonstenotic, asymptomatic ulcerative lesions of the carotid artery. Arch Surg. 1978 Nov;113(11):1352–1359. doi: 10.1001/archsurg.1978.01370230142018. [DOI] [PubMed] [Google Scholar]
  14. Moore W. S., Hall A. D. Importance of emboli from carotid bifurcation in pathogenesis of cerebral ischemic attacks. Arch Surg. 1970 Dec;101(6):708–passim. doi: 10.1001/archsurg.1970.01340300064012. [DOI] [PubMed] [Google Scholar]
  15. O'Hara P. J., Brewster D. C., Darling R. C., Hallett J. W., Jr Oculopneumoplethysmography: its relationship to intraoperative cerebrovascular hemodynamics. Arch Surg. 1980 Oct;115(10):1156–1158. doi: 10.1001/archsurg.1980.01380100008002. [DOI] [PubMed] [Google Scholar]
  16. Riles T. S., Lieberman A., Kopelman I., Imparato A. M. Symptoms, stenosis, and bruit: interrelationships in carotid artery disease. Arch Surg. 1981 Feb;116(2):218–220. doi: 10.1001/archsurg.1981.01380140064014. [DOI] [PubMed] [Google Scholar]
  17. Ropper A. H., Wechsler L. R., Wilson L. S. Carotid bruit and the risk of stroke in elective surgery. N Engl J Med. 1982 Nov 25;307(22):1388–1390. doi: 10.1056/NEJM198211253072207. [DOI] [PubMed] [Google Scholar]
  18. Sumner D. S., Russell J. B., Ramsey D. E., Hajjar W. M., Miles R. D. Noninvasive diagnosis of extracranial carotid arterial disease: a prospective evaluation of pulsed-Doppler imaging and oculoplethysmography. Arch Surg. 1979 Nov;114(11):1222–1229. doi: 10.1001/archsurg.1979.01370350024002. [DOI] [PubMed] [Google Scholar]
  19. Thompson J. E., Kartchner M. M., Austin D. J., Wheeler C. G., Patman R. D. Carotid endarterectomy for cerebrovascular insufficiency (stroke): follow up of 359 cases. Ann Surg. 1966 May;163(5):751–763. doi: 10.1097/00000658-196605000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Thompson J. E., Patman R. D., Talkington C. M. Asymptomatic carotid bruit: long term outcome of patients having endarterectomy compared with unoperated controls. Ann Surg. 1978 Sep;188(3):308–316. doi: 10.1097/00000658-197809000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Treiman R. L., Foran R. F., Cohen J. L., Levin P. M., Cossman D. V. Carotid bruit: a follow-up report on its significance in patients undergoing an abdominal aortic operation. Arch Surg. 1979 Oct;114(10):1138–1140. doi: 10.1001/archsurg.1979.01370340044007. [DOI] [PubMed] [Google Scholar]
  22. Turnipseed W. D., Berkoff H. A., Belzer F. O. Postoperative stroke in cardiac and peripheral vascular disease. Ann Surg. 1980 Sep;192(3):365–368. doi: 10.1097/00000658-198009000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]

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