Skip to main content
SpringerLink
Log in

Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Purpose

The ultrasonographic and hemodynamic features of patients with carotid near-occlusion (CNO) are still not well known. Our aim was to describe the ultrasonographic and hemodynamic characteristics of a cohort of patients with CNO.

Methods

A prospective, observational, nationwide, and multicenter study was conducted from January/2010 to May/2016. Patients with digital subtraction angiography (DSA)–confirmed CNO were included. We collected information on clinical and demographic characteristics, carotid and transcranial ultrasonography and DSA findings, presence of full-collapse, collateral circulation, and cerebrovascular reactivity (CVR).

Results

One hundred thirty-five patients were analyzed. Ultrasonographic and DSA diagnosis of CNO were concordant in only 44%. This disagreement was related to the presence/absence of full-collapse: 45% of patients with CNO with full-collapse were classified as a complete carotid occlusion, and 40% with a CNO without full-collapse were interpreted as severe stenosis (p < 0.001). Mean velocities (mV) and pulsatility indexes (PIs) were significantly lower in the ipsilateral middle cerebral artery compared with the contralateral (43 cm/s vs 58 cm/s, p < 0.001; 0.80 vs 1.00, p < 0.001). Collateral circulation was identified in 92% of patients, with the anterior communicating artery (73%) being the most frequent. CVR was decreased or exhausted in 66% of cases and was more frequent in patients with a poor or absent collateral network compared with patients with ≥ 2 collateral arteries (82% vs 56%, p = 0.051).

Conclusion

The accuracy of carotid ultrasonography in the diagnosis of CNO seems to be limited, with significant discrepancies with DSA. Decreased ipsilateral mV, PI, and CVR suggest a hemodynamic compromise in patients with CNO.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data Availability

Data of the study are available upon reasonable request.

References

  1. Johansson E, Fox A (2016) Carotid near-occlusion: a comprehensive review, Part 1—Definition, terminology, and diagnosis. Am J Neuroradiol. 37:2–10

    Article  CAS  Google Scholar 

  2. Fox AJ, Eliasziw M, Rothwell P, Schmidt M, Warlow C, Barnett H (2005) Identification, prognosis, and management of patients with carotid artery near occlusion. Am J Neuroradiol. 26:2086–2094

    PubMed  Google Scholar 

  3. Rothwell P, Eliasziw M, Gutnikov S, Fox A, Taylor D, Mayberg M, Warlow CP, Barnett HJM (2003) Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 361:107–116

    Article  CAS  Google Scholar 

  4. Rothwell P, Gutnikov S, Warlow C, for the European Carotid Surgery Trial (2003) Reanalysis of the final results of the European Carotid Surgery Trial. Stroke. 34:514–523

    Article  CAS  Google Scholar 

  5. Bartlett E, Walters T, Symons S, Fox A (2006) Diagnosing carotid stenosis near-occlusion by using CT angiography. Am J Neuroradiol. 27:632–637

    CAS  PubMed  Google Scholar 

  6. Khangure S, Benhabib H, Machnowska M, Fox A, Grönlund C, Herod W, Maggisano R, Sjöberg A, Wester P, Hojjat SP, Hopyan J, Aviv RI, Johansson E (2018) Carotid near-occlusion frequently has high peak systolic velocity on Doppler ultrasound. Neuroradiology. 60(1):17–25

    Article  Google Scholar 

  7. Hetzel A, Eckenweber B, Trummer B, Wernz M, Schumacher M, von Reutern G (1998) Colour-coded duplex sonography of preocclusive carotid stenoses. Eur J Ultrasound. 8:183–191

    Article  CAS  Google Scholar 

  8. Ashraf Mansour M, Mattos M, Hood D, Hodgson K, Barkmeier L, Ramsey D et al (1995) Detection of total occlusion, string sign, and preocclusive stenosis of the internal carotid artery by color-flow duplex scanning. Am J Surg. 170:154–158

    Article  Google Scholar 

  9. El-Saden S, Grant E, Hathout G, Zimmerman P, Cohen S, Baker J (2001) Imaging of the internal carotid artery: the dilemma of total versus near total occlusion. Radiology. 221:301–308

    Article  CAS  Google Scholar 

  10. Johansson E, Fox A (2016) Carotid near-occlusion: a comprehensive review, Part 2—Prognosis and treatment, pathophysiology, confusions, and areas for improvement. Am J Neuroradiol. 37:200–204

    Article  CAS  Google Scholar 

  11. Johansson E, Öhman K, Wester P (2015) Symptomatic carotid near-occlusion with full collapse might cause a very high risk of stroke. J Intern Med. 277:615–623

    Article  CAS  Google Scholar 

  12. García-Pastor A, Gil-Núñez A, Ramírez-Moreno J, González-Nafría N, Tejada J, Moniche F et al (2019) The risk of recurrent stroke at 24 months in patients with symptomatic carotid near-occlusion: results from CAOS, a multicentre registry study. Eur J Neurol. 26:1391–1398

    Article  Google Scholar 

  13. Grant E, Benson C, Moneta G, Alexandrov A, Baker J, Bluth E et al (2003) Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology. 229:340–346

    Article  Google Scholar 

  14. Markus H, Harrison M (1992) Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus. Stroke. 23:668–673

    Article  CAS  Google Scholar 

  15. Jiménez-Caballero P, Segura T (2006) Valores de normalidad de la reactividad vasomotora cerebral mediante el test de apnea voluntaria. Rev Neurol. 43:598–602

    PubMed  Google Scholar 

  16. Henderson R, Eliasziw M, Fox A, Rothwell P, Barnett H (2000) Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. Stroke. 31(1):128–132

    Article  CAS  Google Scholar 

  17. Morgenstern L, Fox A, Sharpe B, Eliasziw M, Barnett H, Grotta J (1997) The risks and benefits of carotid endarterectomy in patients with near occlusion of the carotid artery. Neurology. 48:911–915

    Article  CAS  Google Scholar 

  18. Gu T, Aviv R, Fox A, Johansson E (2020) Symptomatic carotid near-occlusion causes a high risk of recurrent ipsilateral ischemic stroke. J Neurol. 267:522–530

    Article  Google Scholar 

  19. Silvestrini M, Troisi E, Matteis M, Cupini L, Caltagirone C (1996) Transcranial Doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis. Stroke. 27:1970–1973

    Article  CAS  Google Scholar 

  20. Terada T, Tsuura M, Matsumoto H, Masuo O, Tsumoto T, Yamaga H, Itakura T (2006) Endovascular treatment for pseudo-occlusion of the internal carotid artery. Neurosurgery. 59:301–309

    Article  Google Scholar 

  21. Choi B, Park J, Shin J, Lü P-H, Kim J, Kim S et al (2010) Outcome evaluation of carotid stenting in high-risk patients with symptomatic carotid near occlusion. Interv Neuroradiol. 16:309–316

    Article  CAS  Google Scholar 

  22. González A, Gil-Peralta A, Mayol A, Gonzalez-Marcos J, Moniche F, Aguilar M et al (2011) Internal carotid artery stenting in patients with near occlusion: 30-day and long-term outcome. Am J Neuroradiol. 32:252–258

    Article  Google Scholar 

  23. Oka F, Ishihara H, Kato S, Oku T, Yamane A, Kunitugu I, Suzuki M (2013) Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion. J Vasc Surg. 58:1512–1517

    Article  Google Scholar 

  24. Rothwell P, Warlow C (2000) Low risk of ischemic stroke in patients with reduced internal carotid artery lumen diameter distal to severe symptomatic carotid stenosis: cerebral protection due to low poststenotic flow? On behalf of the European Carotid Surgery Trialists’ Collaborative. Stroke. 31:622–630

    Article  CAS  Google Scholar 

  25. Molloy J, Markus H (1999) Asymptomatic embolization predicts stroke and TIA risk in patients with carotid artery stenosis. Stroke. 30:1440–1443

    Article  CAS  Google Scholar 

  26. Johansson E, Benhabib H, Herod W, Hopyan J, Machnowska M, Maggisano R et al (2018) Carotid near-occlusion can be identified with ultrasound by low flow velocity distal to the stenosis. Acta radiol. 60(3):396–404

    Article  Google Scholar 

Download references

Acknowledgements

The data shown in this manuscript has been previously presented as an E-Poster Viewing Abstract at the 5th European Stroke Organisation Conference held in Milan, Italy in May 2019.

Funding

This study received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Hospital General Universitario Gregorio Marañón, Neurology, C/ Dr Esquerdo 46, 28007, Madrid, Spain

    Michael Armando Palacios-Mendoza, A. García-Pastor, A. Gil-Núñez & E. Castro-Reyes

  2. Hospital Universitario Infanta Cristina, Neurology, Badajoz, Spain

    J. M. Ramírez-Moreno

  3. Complejo Asistencial Universitario de León, Neurology, Leon, Spain

    N. González-Nafría

  4. Hospital Universitario Virgen del Rocío, Sevilla, Neurology, Sevilla, Spain

    F. Moniche

  5. Hospital San Pedro Alcántara, Neurology, Cáceres, Spain

    J. C. Portilla-Cuenca

  6. Hospital Universitario La Paz, Neurology, Madrid, Spain

    B. Fuentes

  7. Hospital Universitario Virgen Macarena, Neurology, Sevilla, Spain

    M. A. Gamero-García

  8. Hospital Universitario Ramón y Cajal, Neurology, Madrid, Spain

    M. Alonso de Leciñana & J. Masjuan

  9. Corporació Sanitaria Parc Taulí, Neurology, Sabadell, Spain

    D. Canovas-Verge

  10. Hospital Universitario de Getafe, Neurology, Getafe, Spain

    Y. Aladro

  11. Hospital Universitari La Fe, Neurology, Valencia, Spain

    A. Lago

  12. Hospital Universitario de Donostia, Neurology, Donostia, Spain

    A. M. de Arce-Borda

  13. Hospital Universitario de Valladolid, Neurology, Valladolid, Spain

    M. Usero-Ruiz

  14. Hospital de la Santa Creu i Sant Pau, Neurology, Barcelona, Spain

    R. Delgado-Mederos

  15. Hospital General Univeristario de Alicante, Neurology, Alicante, Spain

    A. Pampliega

  16. Hospital Universitario de La Princesa, Neurology, Madrid, Spain

    Á. Ximenez-Carrillo

  17. Hospital Universitario de Burgos, Neurology, Burgos, Spain

    M. Bártulos-Iglesias

Authors
  1. Michael Armando Palacios-Mendoza
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. García-Pastor
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Gil-Núñez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. M. Ramírez-Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. González-Nafría
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. F. Moniche
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. C. Portilla-Cuenca
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. B. Fuentes
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. M. A. Gamero-García
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. Alonso de Leciñana
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. J. Masjuan
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. D. Canovas-Verge
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Y. Aladro
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. A. Lago
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. A. M. de Arce-Borda
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. M. Usero-Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. R. Delgado-Mederos
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. A. Pampliega
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Á. Ximenez-Carrillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. M. Bártulos-Iglesias
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. E. Castro-Reyes
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

on behalf of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group

Corresponding author

Correspondence to Michael Armando Palacios-Mendoza.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study obtained ethics approval from “Comité de Ética e investigación Clínica Hospital General Universitario Gregorio Marañón”, with ID number of the approval: 122/09.

Consent to participate

Participants gave informed consent before taking part in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palacios-Mendoza, M.A., García-Pastor, A., Gil-Núñez, A. et al. Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study. Neuroradiology 63, 705–711 (2021). https://doi.org/10.1007/s00234-020-02567-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-020-02567-w

Keywords

Search

Navigation