Assessment of the Posterior Communicating Artery by Transcranial Color-Coded Duplex Sonography

• Published in: Stroke (1970) Vol. 27; no. 3; pp. 486 - 489
• Main Authors: Klötzsch, Christof, Popescu, Octavian, Berlit, Peter
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.03.1996
• Subjects: Adult; Arteriosclerosis - diagnostic imaging; Arteriosclerosis - physiopathology; Arteriosclerosis - surgery; Biological and medical sciences; Blood Flow Velocity; Carotid Artery, Internal - diagnostic imaging; Carotid Artery, Internal - physiopathology; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - physiopathology; Carotid Stenosis - surgery; Catheterization; Cerebral Angiography; Cerebral Arteries - diagnostic imaging; Cerebral Arteries - physiopathology; Cerebrovascular Circulation; Cerebrovascular Disorders - surgery; Circle of Willis - diagnostic imaging; Circle of Willis - physiopathology; Collateral Circulation; Female; Humans; Male; Medical sciences; Middle Aged; Neurology; Patient Care Planning; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Duplex; Ultrasonography, Doppler, Transcranial; Vascular diseases and vascular malformations of the nervous system; Sonography; Human; Nervous system diseases; Internal carotid; Color; Cardiovascular disease; Exploration; Duplex ultrasonography; Cerebral disorder; Arterial disease; Vascular disease; Transcranial route; Central nervous system disease; Unilateral; Posterior communicating artery; Hemodynamics; Obliteration; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.27.3.486

Background and Purpose The aim of this study was to investigate flow velocity and flow direction in the posterior communicating artery (PcomA) by means of transcranial color-coded duplex sonography (TCCD) and to compare the results with angiographic findings. Methods Thirty patients with unilateral occlusion of the internal carotid artery (ICA) due to atherosclerosis (n=15) or balloon occlusion (n=15) and 50 normal subjects were included. The circle of Willis was insonated through the temporal bone window. In 24 patients with unilateral ICA occlusion, angiograms were available and were compared with the results of TCCD. Results The PcomA could be detected unilaterally in 70% of normal subjects and bilaterally in 30%. A retrograde flow direction in the PcomA from the posterior cerebral artery to the ICA was found in 75% of the normal control subjects. The mean peak flow velocity in normal PcomAs was 36±15 cm/s (±SD). No significant differences in flow velocity were found between unilaterally and bilaterally detectable PcomAs or between retrograde and orthograde PcomAs. In patients with unilateral ICA occlusion we observed ipsilaterally a retrograde flow direction, with an elevation of flow velocity (64±10 cm/s) compared with the contralateral side (27±14 cm/s; P <.001). Conclusions TCCD appears to be a valuable method to determine flow velocity and flow direction not only in the large intracranial vessels but also in the smaller communicating arteries. In the future this method could be useful for the planning of ICA balloon occlusions and in deciding whether to perform extracranial/intracranial bypass surgery. It could furthermore show intracranial collaterals in patients with cerebrovascular disease and help to estimate the risk of watershed infarctions in patients with asymptomatic high-grade ICA stenosis and in patients undergoing carotid endarterectomy.