The reliability of color duplex ultrasound in diagnosing total carotid artery occlusion*

https://doi.org/10.1016/S0002-9610(97)90080-9Get rights and content

Background and purpose: Color duplex ultrasound has been advocated as an alternative to arteriography before carotid endarterectomy. However, one limitation of color duplex ultrasound is that it sometimes fails to differentiate high-grade stenosis from total carotid occlusion. This study was done to determine (1) the accuracy of carotid duplex ultrasound in diagnosing total carotid occlusion, and (2) when angiography is necessary.

Patient population and methods: Carotid duplex ultrasound and angiography results were compared for 520 carotid arteries, and 103 of these had a duplex diagnosis of total carotid occlusion or suspected almost total-to-total occlusion. The diagnosis of total carotid occlusion was primarily based on the absence of flow in the internal carotid artery as visualized on B-mode imaging for at least 1 inch beyond the bifurcation (optimal study). If the internal carotid artery was not optimally seen beyond the bifurcation, but secondary criteria were present, such as dampening of the common carotid signal and internalization of the external carotid artery, a diagnosis of suspected subtotal to total occlusion was made (limited study).

Results: In the optimal studies, 91 arteries had total carotid occlusions and of these, 87 were confirmed by angiography. The accuracy of carotid duplex ultrasound in diagnosing total carotid occlusion was 97% with a positive predictive value of 96%, negative predictive value of 98%, sensitivity of 91%, and specificity of 99%. Twelve arteries were diagnosed as suspected subtotal to total occlusion (limited studies), and of these, three were occluded on angiography, eight had stenoses ranging from 90% to 99%, and one had 80% stenosis.

Conclusions: A carotid duplex ultrasound study is an acceptable method for predicting total carotid occlusion when the study is optimal, and angiography is unnecessary in asymptomatic patients. Angiography is recommended for patients who are surgical candidates with a limited duplex study.

References (12)

There are more references available in the full text version of this article.

Cited by (67)

  • Detection of Anomalous Cervical Internal Carotid Artery Branches by Colour Duplex Ultrasound

    2017, European Journal of Vascular and Endovascular Surgery
    Citation Excerpt :

    Patients with greater than 70% stenoses within the ICAs were included, and patients with greater than 70% stenoses and a concomitant ICA branch were excluded. The reason for predefined criteria excluding cases with 70% or greater stenosis and a concomitant branch was on the basis that the presence of significant disease may influence the development of “internalisation” of the external carotid artery, 18,19 secondary to collateral supply to the intracranial circulation from the ECA through the peri-orbital branches.20 The origin of each ICA branch was identified using B mode and CDU.

  • The essentials of extracranial carotid ultrasonographic imaging

    2014, Radiologic Clinics of North America
    Citation Excerpt :

    A bilateral pattern suggests increased intracranial pressure, diffuse intracerebral vasospasm, or arteritis. Internalization of the ECA waveform occurs in the setting of an ipsilateral ICA occlusion or high-grade stenosis, in which case the ECA switches from a high-resistance to a low-resistance waveform pattern as the vessel is recruited to provide cerebral blood flow (Fig. 8A).6 The cause of this increased diastolic flow is believed to be secondary to collateral vessel formation between the distal ICA and the ECA via the ophthalmic bed or through superficial vessels.7,8

  • Association between carotid artery occlusion and ultrasonographic plaque type

    2014, Annals of Vascular Surgery
    Citation Excerpt :

    More specifically, it has been proposed that embolus within the ECA on angiography in stroke patients with ICA occlusion allows confident ascription to a proximal, usually cardiac, source.15 Duplex ultrasound imaging is the first-line noninvasive method for the diagnosis of carotid artery disease, featuring a high sensitivity (95%), specificity (100%), and accuracy (97%), for differentiating a true occlusion from a near occlusion.7,16,17 It has been proposed that angiography is unnecessary in asymptomatic patients and may be recommended for patients who are surgical candidates after a limited duplex study.7

  • Validation of ultrasound parameters to assess collateral flow via ophthalmic artery in internal carotid artery occlusion

    2014, Journal of Stroke and Cerebrovascular Diseases
    Citation Excerpt :

    Diagnosis of complete occlusion can be complicated by the presence of large ECA collaterals via OA, which can be mistaken for the ICA.10,11 The conversion to a low-resistance Doppler sonography waveform in the ECA has been termed “internalization” because the abnormal spectral tracings in the ECA mimic the spectral tracings in a normal ICA.12 This change is often because of complete occlusion of the ICA with subsequent development of low-resistance collateral pathways between the ipsilateral external and internal circulation, typically through the ophthalmic vascular bed.13

View all citing articles on Scopus
*

Presented at the 25th Annual Meeting of The Society for Clinical Vascular Surgery, Naples, Florida, March 12–16.1997.

1

From the Department of Surgery (AFAR, JAP, DM), Robert C. Byrd Health Sciences Center, West Virginia University, Charleston Area Medical Center, Charleston, West Virginia; Ridgefield, Connecticut (PAR).

View full text