Vertebral artery Doppler waveform patterns for exclusive diagnosis of basilar artery stenosis and occlusion.

PURPOSE: The aim of this study was to evaluate the usefulness of vertebral artery (VA) pulsed Doppler waveform changes in excluding basilar artery (BA) stenosis/occlusion.

METHODS

One-hundred and twenty-two patients with time-averaged peak flow velocity (MV) of bilateral VAs <18 cm/s, measured by carotid ultrasonography, were included. The pulsatility index (PI) and resistive index (RI) of both VAs were measured. The maximum PI (Max PI) and maximum RI (Max RI) were used for analysis, respectively. BA stenosis/occlusion and fetal-type posterior cerebral artery (f-PCA) were evaluated using MR angiography.

RESULTS

Thirty-six patients had BA stenosis/occlusion. Acute infratentorial cerebral infarction (CI), f-PCA, Max PI, and Max RI were significantly higher in patients with BA stenosis/occlusion. Multiple logistic regression analysis revealed that "Max PI ≥2.00 or Max RI ≥0.82" had an odds ratio of 3.75 (95% CI 1.43-9.84) for diagnosing BA stenosis/occlusion, but the positive predictive value (PPV) was low (42.2%) and negative predictive value (NPV) was high (84.5%). Similarly, "Max PI ≥2.00 and Max RI ≥0.82" had an odds ratio of 2.96 (95% CI 1.18-7.39); PPV was low (44.9%) and NPV was high (80.8%).

CONCLUSION

Among the subjects with bilateral VA-MV <18 cm/s, PI and RI could contribute to excluding BA stenosis/occlusion.