T.C.C.D. for the detection of vertebrobasilar pathology

Intracranial vertebrobasilar (V-B) stenosis is an important cause of ischemic stroke. Transcranial color Doppler (T.C.C.D.) seems to be an accurate method for the detection of stenosis in intracranial V-B circulation. The aim of this study was to assess the value of T.C.C.D. versus angiography and angioR.M.N in detecting V-B stenosis. Subjects and methods. The T.C.C.D. criteria for diagnosis of V-B. stenosis were: (a) Hemodynamic stenosis of intracranial vertebral artery: peak systolic velocity>120 cm/s; (b) intracranial vertebral artery occlusion: high-resistance flow in the extracranial vertebral artery and no flow in the intracranial vertebral artery; (c) hemodynamic stenosis of the basilar artery: peak systolic velocity >140 cm/s; and (d) acute occlusion of basilar artery: high-resistance flow in the extracranial vertebral arteries and no flow in the basilar artery. We studied 36 patients (12 women, 24 men, mean age = 61 years, min.=40, max.=83 ) who presented these T.C.C.D findings. Afterwards, these patients were studied by intraarterial angiography (13) or angio RMN (23). In the whole population an extracranial vertebral ultrasound approach preceded T.C.C.D. In these T.C.C.D studies we did not use contrasts agents. Results. Using the previously mentioned T.C.C.D. criteria we diagnosed: (a) 12 intracranial vertebral artery stenoses; (b) 12 intracranial vertebral artery occlusions; (c) 9 basilar artery stenoses; and (d) 3 basilar artery occlusions. The neuroradiological studies (N.R.S.) were concordant with T.C.C.D.diagnosis in 31 patients. There were 5 T.C.C.D. failures: T.C.C.D diagnosed 5 V-B occlusions while N.R.S. diagnosed hemodynamic stenosis. In 5 patients of group (a) and (b) vertebral dissection was diagnosed by T.C.C.D. and N.R.S. In 4 of these patients T.C.C.D. demonstrated, 30 days after, recovery of the lesion with regular intravascular flow. Conclusion. In our opinion TCCD is: (a) An effective screening test for V-B stenosis; (b) very useful for planning a correct medical or surgical therapy; (c) the first approach for selecting patients which can be evaluated with N.R.S. for possible thrombolytic and/or interventional therapy.