Comparison of serebral angiography and color doppler examination in distal vertebrobasilar artery obstructions

Purpose: To evaluate color-coded Duplex ultrasound (CDUS) waveform patterns for distal vertebrobasilar pathologies and compare with Digital Subtraction Angiography (DSA). Material and Methods: CDUS studies of 200 patients with 400 vertebral arteries (VAs) who underwent DSA for different reasons between January 2017 and January 2018 were retrospectively analyzed. Peak-systolic velocities (PSV), end-diastolic velocities (EDV), time-averaged maximum velocity (TAMAX), pulsatility (PI) and resistive index (RI) were measured for each VA. Based on the Doppler findigns, VAs were divided into 3 groups as follows: (1) normal waveform patterns (n=341), (2) normal velocity and high resistance (n=54), (3) low velocity and high resistance (n=5). VAs with TAMAX<18 cm/s were analyzed statistically. Results: Min TAMAX and Min EDV were significantly lower in the high resistive group compared with normal group (10,8±5,0 cm/s, 5,3±4,2 cm/s, respectively. p=0,000). Fifteen of the 59 vessels with high resistance flow were PICA ending; sensitivity, specificity, false negative value, false positive value and accuracy were 49 %, 100 %, 51 %, 0 %, and 92 %, respectively (p=0.001). Five of 25 vessels (25 %) with RI≥0,8, 11 of 37 vessels (29 %) with TAMAX<18 cm/s had in PICA ending. PICA ending 29 VAs detected according to DSA. Min TAMAX and Min EDV (11,2±4,3 cm/s, 20,9±7,0 cm/s, respectively, p=0,007) were significantly lower in the PICA ending group compared with normal group (17,2±6,0 cm/s, 29,5±8,4 cm/s, respectively). Conclusion: High resistive Doppler signal in the VA may be associated with distal vertebrobasilar pathology. Therfore, further examination should be performed in the high resistive waveformes with corelation of clinical findings. Keyword: DSA, Duplex ultrasound, resistive index, TAMAX, vertebrobasilary arteries