Assessment of anterior circulation cerebral artery atherosclerosis with combination of carotid color Doppler ultrasonography and transcranial Doppler ultrasonography

Objective To evaluate the application of combined carotid color Doppler ultrasonography and transcranial Doppler (TCD) in examining the extent of anterior circulation cerebral artery atherosclerosis in patients with acute ischemic stroke, and to discuss its clinical significance. Methods One hundred and seven 50-85 years old patients with acute anterior circulation ischemic stroke accepted carotid color Doppler ultrasonography and TCD within 2 weeks after onset. Recorded different echo plaque, plaque size, and artery stenosis extent at CT/MRI positive and negative side of common carotid artery/extracranial internal carotid artery (CCA/EICA) in the extracranial carotid artery stenosis group; recorded the stenosis extent at CT/MRI positive and negative side of siphon segment of internal carotid artery (SCA), terminal segment of internal carotid artery (TICA), middle cerebral artery M1 segment (MCA-M1), anterior cerebral artery A1 segment (ACA-A1), and the detectable rate of different echo plaque at both sides of CCA/EICA in the anterior circulation intracranial vascular stenosis group; and recorded the arterial stenosis extent at CT/MRI positive and negative side of CCA/EICA, MCA-M1, and ACA-A1 in the combined anterior circulation intracranial and extracranial artery stenosis group. Results In the extracranial carotid artery stenosis group, the different echo plaque size and positive detectable rate between CT/MRI positive side and negative side of CCA/EICA presented no significant differences (P 0.05); when the stenosis extent of CCA/EICA was 40%-50% and 50%-70%, there were no significant differences in the positive detectable rates of stenotic vascular between both sides (P 0.05); when stenosis extent achieved 70%-90% or 90%, detectable rates at CT/MRI positive side were all higher than those at negative side (P 0.05). In anterior circulation intracranial vascular stenosis group, no significant differences in different echo plaque size and positive detectable rate were found between CT/MRI positive side and negative side of CCA/EICA (P 0.05), the stenosis incidence rates of SCA/TICA and MCA-M1 of CT/MRI positive side were higher than those of CT/MRI negative side (P 0.05), there were no significant differences in stenosis incidence rate at ACA-A1 between both sides (P 0.05). In the combined anterior circulation intracranial and extracranial artery stenosis group, the positive detectable rates of CCA/EICA stenosis extent 70% and MCA-M1 stenosis at CT/MRI positive side were all higher than those at CT/MRI negative side (P 0.05), the differences in positive detectable rates between both sides of ACA-A1 stenotic vascular was not significant (P 0.05). Conclusion The progressive extent of carotid artery atherosclerosis was essentially similar in the same group of patients with cerebral atherosclerosis. According to the presentation of plaque echo and ulcer, we cannot define the ″responsible″ plaque of artery-arterial embolism. CCA/EICA stenosis extent 70% indicated by carotid color Doppler sonography, and SCA, TICA, and MCA-M1 stenosis extent ≥ 50% examined by TCD are apparently related to the occurrence of stroke at the same side. The combination of the two methods can be useful for defining the ″responsible″ artery in acute ischemic stroke.