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American Journal of Neuroradiology 26:957-962, April 2005
© 2005 American Society of Neuroradiology

HEAD AND NECK

Reappraisal of Flow Velocity Ratio in Common Carotid Artery to Predict Hemodynamic Change in Carotid Stenosis

Masahiro Kamouchi^a,c, Kazuhiro Kishikawa^a, Yasushi Okada^a, Tooru Inoue^b, Setsuro Ibayashi^c and Mitsuo Iida^c

^a Department of Cerebrovascular Disease, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, Kyushu University, Fukuoka, Japan
^b Department of Neurosurgery, Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, Kyushu University, Fukuoka, Japan
^c Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Address correspondence to Masahiro Kamouchi, MD, PhD, Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan

BACKGROUND AND PURPOSE: Various Doppler criteria have been used to predict hemodynamically significant carotid stenosis. This study was performed to elucidate whether hemodynamically significant stenosis can be predicted indirectly by the blood flow velocity in the common carotid artery (CCA) measured with duplex ultrasonography in patients with unilateral stenosis of internal carotid artery (ICA).

METHODS: Eighty-five patients who were scheduled to undergo carotid endarterectomy for unilateral stenosis of ICA origin were analyzed. The flow velocities and their side-to-side ratios in the CCA were calculated. The flow velocities in the CCA were measured with conventional ultrasonography and poststenotic blood flow with transoral carotid ultrasonography. Cerebral angiography was performed to evaluate the intracranial collateral flow.

RESULTS: Among the absolute values and side-to-side ratios of Doppler flow velocities in the CCA, the end diastolic flow velocity (EDV) ratio in the CCA best correlated with the residual lumen area (r = 0.35; P = .0009), stenosis of diameter (r = 0.48; P < .0001), and poststenotic flow (r = 0.60; P < .0001). EDV ratios in the CCA were significantly lower in patients with collateral pathways (anterior communicating artery, P = .0005; posterior communicating artery, P = .004; ophthalmic artery, P < .0001; leptomeningeal collateral, P = .004). The optimal threshold value of the EDV ratio in the CCA for the presence of intracranial collateral flow and stenosis of diameter 70% was 1.2. Those for tight stenosis in a cross-sectional area >95%, the reduction of poststenotic flow, and poststenotic narrowing were 1.4, 1.5, and 1.6, respectively.

CONCLUSION: The EDV ratio in the CCA appears to be an additional parameter for predicting hemodynamically significant stenosis in patients with unilateral ICA stenosis.

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