Velocity criteria for intracranial stenosis revisited

An international multicenter study of transcranial Doppler and digital subtraction angiography

Limin Zhao, Kristian Barlinn, Vijay K. Sharma, Georgios Tsivgoulis, Luis F. Cava, Spyros N. Vasdekis, Hock Luen Teoh, Nikos Triantafyllou, Bernard P.L. Chan, Arvind Sharma, Konstantinos Voumvourakis, Elefterios Stamboulis, Maher Saqqur, Mark R. Harrigan, Karen C. Albright, Andrei Alexandrov

Research output: Contribution to journalArticle

54 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)3429-3434
Number of pages6
JournalStroke
Volume42
Issue number12
DOIs
StatePublished - Dec 1 2011

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Digital Subtraction Angiography
Multicenter Studies
Pathologic Constriction
Intracranial Arteriosclerosis
Stroke
Basilar Artery
Vertebral Artery
Middle Cerebral Artery
Neuroimaging
Sensitivity and Specificity
National Institutes of Health (U.S.)
Warfarin
Brain Ischemia
ROC Curve
Aspirin
Angiography
Arteries
Recurrence

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Velocity criteria for intracranial stenosis revisited : An international multicenter study of transcranial Doppler and digital subtraction angiography. / Zhao, Limin; Barlinn, Kristian; Sharma, Vijay K.; Tsivgoulis, Georgios; Cava, Luis F.; Vasdekis, Spyros N.; Teoh, Hock Luen; Triantafyllou, Nikos; Chan, Bernard P.L.; Sharma, Arvind; Voumvourakis, Konstantinos; Stamboulis, Elefterios; Saqqur, Maher; Harrigan, Mark R.; Albright, Karen C.; Alexandrov, Andrei.

In: Stroke, Vol. 42, No. 12, 01.12.2011, p. 3429-3434.

Research output: Contribution to journalArticle

Zhao, L, Barlinn, K, Sharma, VK, Tsivgoulis, G, Cava, LF, Vasdekis, SN, Teoh, HL, Triantafyllou, N, Chan, BPL, Sharma, A, Voumvourakis, K, Stamboulis, E, Saqqur, M, Harrigan, MR, Albright, KC & Alexandrov, A 2011, 'Velocity criteria for intracranial stenosis revisited: An international multicenter study of transcranial Doppler and digital subtraction angiography', Stroke, vol. 42, no. 12, pp. 3429-3434. https://doi.org/10.1161/STROKEAHA.111.621235
Zhao, Limin ; Barlinn, Kristian ; Sharma, Vijay K. ; Tsivgoulis, Georgios ; Cava, Luis F. ; Vasdekis, Spyros N. ; Teoh, Hock Luen ; Triantafyllou, Nikos ; Chan, Bernard P.L. ; Sharma, Arvind ; Voumvourakis, Konstantinos ; Stamboulis, Elefterios ; Saqqur, Maher ; Harrigan, Mark R. ; Albright, Karen C. ; Alexandrov, Andrei. / Velocity criteria for intracranial stenosis revisited : An international multicenter study of transcranial Doppler and digital subtraction angiography. In: Stroke. 2011 ; Vol. 42, No. 12. pp. 3429-3434.
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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.",
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T1 - Velocity criteria for intracranial stenosis revisited

T2 - An international multicenter study of transcranial Doppler and digital subtraction angiography

AU - Zhao, Limin

AU - Barlinn, Kristian

AU - Sharma, Vijay K.

AU - Tsivgoulis, Georgios

AU - Cava, Luis F.

AU - Vasdekis, Spyros N.

AU - Teoh, Hock Luen

AU - Triantafyllou, Nikos

AU - Chan, Bernard P.L.

AU - Sharma, Arvind

AU - Voumvourakis, Konstantinos

AU - Stamboulis, Elefterios

AU - Saqqur, Maher

AU - Harrigan, Mark R.

AU - Albright, Karen C.

AU - Alexandrov, Andrei

PY - 2011/12/1

Y1 - 2011/12/1

N2 - 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.

AB - 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.

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