What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Intracranial and extracranial arterial disease (n=309). Intervention: Symptomatic status (history of TIA, stroke, or carotid bruits) vs. Asymptomatic high-risk status. Primary outcome: Presence of any degree of intracranial or extracranial arterial stenosis (p=0.4648).

January 1, 2002Open Access

The importance of Doppler studies in asymptomatic intracranial and extracranial arterial disease.

PHPeter HermesUniversity of Bonn

Key Result

The frequency of intracranial or extracranial arterial stenosis was similarly high in symptomatic patients (83%) and high-risk asymptomatic patients (81%), with no significant difference between the groups (p=0.4648).

Study Design

Type

Cross-Sectional (n=309)

Structured PICO

What is the prevalence of carotid and intracranial stenosis detected by Doppler ultrasound in symptomatic versus asymptomatic high-risk elderly patients?

Population

309 seniors (204 symptomatic and 105 asymptomatic at high risk for stroke) evaluated for intracranial and extracranial arterial stenosis using Doppler sonography.

Exposure

Carotid duplex ultrasound and transcranial doppler

Comparator

Symptomatic versus asymptomatic patients

Outcome

Presence of carotid and intracranial stenosissurrogate

There is a high prevalence of intracranial and extracranial arterial disease in both symptomatic and asymptomatic elderly patients at high risk for stroke, highlighting the potential utility of Doppler screening.

Main Result

Absolute Event Rate: 83% vs 81%

p-value: p=0.4648

Limitations

Study population does not reflect the epidemiologic incidence of stroke risk and symptomatology in the general population.
Only the velocity shift of the middle cerebral artery was analyzed, which can be altered by other medical conditions like anemia or congestive heart failure.
Tandem stenosis and concomitant extracranial stenosis may alter transcranial Doppler results.
Lack of validation with angiography or sophisticated B-mode studies for intracranial circulation.

Abstract

Knowledge of intracranial and carotid disease in the symptomatic and especially the asymptomatic high risk population may be useful for evaluating future treatment modalities. A group of 204 symptomatic patients and 105 asymptomatic elderly patients at high risk for stroke were tested by carotid duplex ultrasound and transcranial doppler for the presence of carotid and intracranial stenosis. Quantitative measurements of the stenosis were made directly from the hard copy of the carotid duplex and the transcranial doppler. Of the 204 symptomatic patients 168 (83%) had some degree of stenosis: 84 of the 204 (41%) in the intracranial circulation only, 59 (29%) in the internal carotid only, and 26 (13%) in both sets of vessels. Of the asymptomatic patients 85 (81%) had some degree of stenosis; 31 of 105 (30%) in the intracranial circulation only, 35 (33%) in the internal carotid only, and 19 (18%) in both sets of vessels. Statistical analysis did not reveal significant differences between the two groups. The large percentage of intracranial disease in the symptomatic as well as the asymptomatic population at high risk for stroke require further confirmation by good duplex studies of the intracranial circulation. This is important in order to create coherent treatment protocols.

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