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Title: Velocity criteria for intracranial stenosis revisited: An international multicenter study of transcranial Doppler and digital subtraction angiography
Authors: Zhao, L.
Barlinn, K.
Sharma, V.K. 
Tsivgoulis, G.
Cava, L.F.
Vasdekis, S.N.
Teoh, H.L. 
Triantafyllou, N.
Chan, B.P.L.
Sharma, A.
Voumvourakis, K.
Stamboulis, E.
Saqqur, M.
Harrigan, M.R.
Albright, K.C.
Alexandrov, A.V.
Keywords: Digital subtraction angiography
Intracranial stenosis
Transcranial Doppler
Issue Date: Dec-2011
Citation: Zhao, L., Barlinn, K., Sharma, V.K., Tsivgoulis, G., Cava, L.F., Vasdekis, S.N., Teoh, H.L., Triantafyllou, N., Chan, B.P.L., Sharma, A., Voumvourakis, K., Stamboulis, E., Saqqur, M., Harrigan, M.R., Albright, K.C., Alexandrov, A.V. (2011-12). Velocity criteria for intracranial stenosis revisited: An international multicenter study of transcranial Doppler and digital subtraction angiography. Stroke 42 (12) : 3429-3434. ScholarBank@NUS Repository.
Abstract: Background and Purpose: Intracranial atherosclerotic disease is associated with a high risk of stroke recurrence. We aimed to determine accuracy of transcranial Doppler screening at laboratories that share the same standardized scanning protocol. Methods: Patients with symptoms of cerebral ischemia were prospectively studied. Stroke Outcomes and Neuroimaging of Intracranial Atherosclerosis (SONIA) criteria were used for identification of ≥50% stenosis. We determined velocity cutoffs for ≥70% stenosis on digital subtraction angiography by Warfarin-Aspirin Symptomatic Intracranial Disease criteria and evaluated novel stenotic/prestenotic ratio and low-velocity criteria. Results: A total of 102 patients with intracranial atherosclerotic disease (age 57 ±13 years; 72% men; median National Institutes of Health Stroke Scale 3, interquartile range 6) provided 690 transcranial Doppler/digital subtraction angiography vessel pairs. On digital subtraction angiography, ≥50% stenosis was found in 97 and ≥70% stenosis in 62 arteries. Predictive values for transcranial Doppler SONIA criteria were similar (P>0.9) between middle cerebral artery (sensitivity 78%, specificity 93%, positive predictive value 73%, negative predictive value 94%, and overall accuracy 90%) and vertebral artery/basilar artery (69%, 98%, 88%, 93%, and 92%). As a single velocity criterion, most sensitive mean flow velocity thresholds for ≥70% stenosis were: middle cerebral artery >120 cm/s (71%) and vertebral artery/basilar artery >110 cm/s (55%). Optimal combined criteria for ≥70% stenosis were: middle cerebral artery >120 cm/s, or stenotic/prestenotic ratio ≥3, or low velocity (sensitivity 91%, specificity 80%, receiver operating characteristic 0.858), and vertebral artery/basilar artery >110 cm/s or stenotic/prestenotic ratio ≥3 (60%, 95%, 0.769, respectively). Conclusions: At laboratories with a standardized scanning protocol, SONIA mean flow velocity criteria remain reliably predictive of ≥50% stenosis. Novel velocity/ratio criteria for ≥70% stenosis increased sensitivity and showed good agreement with invasive angiography. © 2011 American Heart Association, Inc.
Source Title: Stroke
ISSN: 00392499
DOI: 10.1161/STROKEAHA.111.621235
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