Value of duplex ultrasound in the diagnosis of extracranial internal carotid stenosis in patients with cerebral infarction

Abstract

Background: Extracranial carotid artery stenosis is one of the main causes of cerebral infarction, estimated to cause approximately 8-15% of cerebral infarctions. The correct diagnosis of this pathology contributes to the clinician's ability to predict the patient's prognosis and select the appropriate treatment. Duplex ultrasound can be used as a non-invasive and inexpensive diagnostic tool to detect carotid artery stenosis in the extracranial segment.

Objectives: The objective of our study is to describe the clinical features, characteristics of duplex ultrasound and evaluate the value of duplex ultrasound for the diagnosis of extracranial internal carotid stenosis in patients with cerebral infarction.

Materials and methods: A prospective cross-sectional study involving 64 brain infarction patients (128 internal carotid arteries on both sides) at Can Tho Central Hospital from 03/2021 to 06/2023.

Results: The clinical symptoms of cerebral infarction include weakness/ hemiplegia (95.3%) and central facial paralysis (62.5%). Cerebral infarction patients had 62.5% of extracranial internal carotid artery stenosis/occlusion. Duplex ultrasound has high value in the diagnosis of extracranial intracranial carotid artery stenosis with sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 96.6%, 99.0%, 98.4%, 96.6% and 99.0%, respectively, very high consensus (= 0.955, 95% CI = 0.894 - 1, p < 0.001) when the narrowness ≥ 50%, with a narrowing ≥ 70%, the values are 92.3%, 99.1%, 98.4%, 92.3%, and 99.1%, respectively, the consensus is also very high ( = 0.914, 95% CI = 0.796 - 1, p < 0.001) compared to DSA. Duplex ultrasound and DSA have a high correlation in the diagnosis of extracranial internal carotid atery stenosis (Spearman’s rs = 0.728, 95% CI: 0.632 - 0.803, p < 0.001).

Conclusion: Duplex ultrasound is a non-invasive, inexpensive, safe and highly accurate imaging tool for diagnosing intracranial carotid artery stenosis, which can be used as an initial screening tool for stenosis classification and/or as a definitive diagnostic method.