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From the Neurological Institute (Drs. Steinke and Mohr), Columbia Presbyterian Medical Center, New York, NY, and the Department of Neurology (Drs. Hennerici and Rautenberg), University of Heidelberg, Klinikum Mannheim, Germany.
We examined 63 patients with 31 symptomatic and 44 asymptomatic carotid stenoses with Doppler colorflow imaging (DCFI); conventional Doppler duplex had shown a hemodynamic obstruction (
80% stenosis) in all patients. Analysis of plaque surface morphology demonstrated more ulcerated plaques in symptomatic (43%) than asymptomatic (23%) stenoses. Although the frequency of homogeneous and heterogeneous plaques was not different, calcific lesions were more frequent in asymptomatic (46% versus 29%), and echolucent plaques, probably indicating mural thrombi, were more frequent in symptomatic (29% versus 11%) stenosis. Color-coded hemodynamic patterns, such as jet flow, poststenotic turbulence, or reversed flow, were not different in symptomatic and asymptomatic stenoses. Comparison of DCFI with 30 angiograms showed agreement in plaque surface analysis in 70%. DCFI measurements of area reduction in cross sections correlated with angiography in 85%, while DCFI tended to underestimate the degree of stenosis from diameter reduction in longitudinal cuts. The advanced DCFI technique identified distinct morphologic features but no hemodynamic patterns, separating symptomatic from asymptomatic high-grade carotid stenoses.
Address correspondence and reprint requests to Dr. Wolfgang Steinke, Neurologische Klinik der Universität Heidelberg, Klinikum Mannheim, Theodor-Kutzer-Ufer, 6800 Mannheim, Germany.
Dr. Steinke is a research fellow supported by grants from the Deutsche Forschungsgemeinschaft, Bonn, Germany.
Presented in part at the 43rd annual meeting of the American Academy of Neurology, Boston, MA, April 1991.
Received May 9, 1991. Accepted for publication in final form June 19, 1991.
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