Clinical and transcranial doppler evaluation of patients with suspected vertebrobasilar insufficiency at Assiut University Hospital

Background Vertebrobasilar insufficiency (VBI) is reduced blood flow in the vertebral-basilar circulation. This study aimed to evaluate the diagnostic performance of transcranial Doppler (TCD) hemodynamic parameters for detecting VBI and to assess the clinical and vascular factors associated with VBI. A cross-sectional observational study was conducted on 150 patients with vertigo of central origin, syncopal attacks, vertebrobasilar transient ischemic attack (TIA), and frequent imbalance that was not related to aural origin or explained by other pathology, who underwent clinical examination and imaging with the diagnosis standard of VBI, including vertebrobasilar TIA. Results Dizziness, smoking, and hyperlipidemia were significantly more frequent in the VBI group ( P < 0.001). Hemodynamically, significant differences were observed in right distal common carotid artery diastolic velocity (DV), bilateral vertebral artery systolic and diastolic velocities, proximal basilar artery systolic and diastolic velocities, and left middle cerebral artery M1 DV ( P < 0.05). Vertebral and basilar systolic velocities were less negative in the VBI group, indicating lower absolute systolic velocity (SV) magnitudes, whereas diastolic velocities were more negative, indicating higher absolute DV magnitudes. Receiver operating characteristic (ROC) analysis showed that vertebral and basilar Doppler parameters had significant diagnostic value for VBI ( P ≤ 0.001), with the highest accuracy for vertebral SV (left) (area under the curve (AUC) = 0.865), vertebral DV (left) (AUC = 0.838), and basilar proximal SV (AUC = 0.841). Conclusions Changes in vertebral and basilar artery flow on transcranial duplex were associated with VBI, supporting its use as a noninvasive diagnostic tool.