Vertebral artery occlusion in duplex color-coded ultrasonography.
OBJECTIVE
To establish the diagnostic criteria for the site of occlusion in the vertebral arteries (VAs) using duplex color-coded ultrasonography.


METHODS
In 128 consecutive patients who underwent conventional cerebral angiography, we prospectively measured the diameter, mean flow velocity (MV), peak systolic flow velocity, and end-diastolic flow velocity of both VAs. The diameter-ratio (diameter of contralateral VA divided by that of target VA) and MV-ratio (MV of contralateral VA divided by that of target VA) were determined. Based on the angiographic findings, we classified the VAs into 4 types (5 groups) as follows: (1) the origin of VA occlusion (Origin group: n=9); (2) VA occlusion before branching into the posterior inferior cerebellar artery (PICA) (Before group: n=10); (3A) symptomatic VA occlusion after branching into the PICA (After group: n=12); (3B) asymptomatic or hypoplastic occlusive VA after branching into the PICA (PICA end group: n=15); and (4) no significant occlusive lesions in the VA (Control group: n=194).


RESULTS
No flow signals in the VAs apparently indicated the Origin group. Preserved peak systolic flow velocity but end-diastolic flow velocity of zero cm/s indicated the Before group. MV <18 cm/s and MV-ratio > or =1.4 indicated the PICA end group or After group. Furthermore, these groups could be distinguished as follows: a diameter-ratio <1.4 indicated the After group. A diameter-ratio > or =1.4 indicated the PICA end group. Either MV > or =18 cm/s or MV <18 cm/s in combination with MV-ratio <1.4 indicated the Control group.


CONCLUSIONS
Duplex color-coded ultrasonography can accurately diagnose the site of VA occlusion.
Saito
Kozue
K
Cerebrovascular Division, of Medicine, National Cardiovascular Center, Japan. ksaito@hsp.ncvc.go.jp
Kimura
Kazumi
K
Nagatsuka
Kazuyuki
K
Nagano
Keiko
K
Minematsu
Kazuo
K
Ueno
Satoshi
S
Naritomi
Hiroaki
H
D015901:Angiography, Digital Subtraction; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D001158:Arteries / Q000000981:diagnostic imaging; D001783:Blood Flow Velocity; D002531:Cerebellum / Q000098:blood supply; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D014711:Vertebral Artery / Q000000981:diagnostic imaging*