Velocity Criteria for Intracranial Stenosis Revisited

• DOI: 10.1161/strokeaha.111.621235
• Publication Date: 2011-09-30T11:52:01Z
• Authors: Limin Zhao; Kristian Barlinn; Vijay K. Sharma; Georgios Tsivgoulis; Luis F. Cava; Spyros N. Vasdekis; Hock Luen Teoh; Nikos Triantafyllou; Bernard P.L. Chan; Arvind Sharma; Konstantinos Voum...; Elefterios Stambo...; Maher Saqqur; Mark R. Harrigan; Karen C. Albright; Andrei V. Alexandrov
• Keywords: Digital subtraction angiography; Transcranial Doppler; Stroke; Posterior cerebral artery

Background and Purpose— Intracranial atherosclerotic disease is associated with a high risk of stroke recurrence. We aimed to determine accuracy transcranial Doppler screening at laboratories that share the same standardized scanning protocol. Methods— Patients symptoms cerebral ischemia were prospectively studied. Stroke Outcomes Neuroimaging Atherosclerosis (SONIA) criteria used for identification ≥50% stenosis. determined velocity cutoffs ≥70% stenosis on digital subtraction angiography by Warfarin–Aspirin Symptomatic Disease evaluated novel stenotic/prestenotic ratio low-velocity criteria. Results— A total 102 patients intracranial (age 57±13 years; 72% men; median National Institutes Health Scale 3, interquartile range 6) provided 690 Doppler/digital vessel pairs. On angiography, was found in 97 62 arteries. Predictive values SONIA similar ( P >0.9) between middle artery (sensitivity 78%, specificity 93%, positive predictive value 73%, negative 94%, overall 90%) vertebral artery/basilar (69%, 98%, 88%, 92%). As single criterion, most sensitive mean flow thresholds were: >120 cm/s (71%) >110 (55%). Optimal combined cm/s, or ≥3, low 91%, 80%, receiver operating characteristic 0.858), ≥3 (60%, 95%, 0.769, respectively). Conclusions— At protocol, remain reliably Novel velocity/ratio increased sensitivity showed good agreement invasive angiography.