Detecting artery occlusion and critical flow diminution in the case of an acute ischemic stroke--methodological pitfalls of common vascular diagnostic methods.
OBJECTIVE
None of the vascular emergency diagnostic methods commonly used in the case of acute ischemic stroke, i. e. CTA, color-coded duplex sonography (CCDS), MRA, and DSA, is free of restrictions due to physical and physiological characteristics. As a result, misleading results initiating an inappropriate acute therapeutic intervention or hampering a promising one cannot be excluded. We aimed to assess the type and frequency of methodological pitfalls occurring in this situation.


METHODS
We retrospectively analyzed data of 269 consecutive patients admitted to our stroke unit with a clinical syndrome of an acute stroke. All patients underwent one or more vascular emergency diagnostic methods on a routine basis.


RESULTS
37 patients were excluded because of a final diagnosis other than ischemic stroke. 76 of 232 ischemic stroke patients underwent emergency diagnostic methods with two or more vascular examination techniques. Controversial results occurred in 20 patients and related to the detection and localization of large artery occlusion and its differentiation from a low/slow flow situation and the identification of critical cerebral flow diminution distal to large artery occlusion/severe stenosis. Methodological pitfalls were able to be most reliably resolved by CCDS. Within the whole cohort of ischemic stroke patients, vascular constellations susceptible to misinterpretation were diagnosed in 40 (17.2 %) patients.


CONCLUSIONS
We recommend providing several techniques including CCDS in an emergency stroke setting and applying techniques with respect to diagnostic findings.
Department of Neurology, Otto-von-Guericke University, Magdeburg. stefanie.schreiber@med.ovgu.de
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Schreiber
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Schreiber
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Glaser
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Skalej
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Heinze
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Goertler
D000368:Aged; D015901:Angiography, Digital Subtraction; D001783:Blood Flow Velocity / Q000502:physiology*; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging*; D003097:Collateral Circulation / Q000502:physiology; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
D003287:Contrast Media