Doppler flow characteristics of extracranial arteries predict aortic valve pathologies in patients with ischemic stroke

Background and Aims Neurovascular ultrasound (nvUS) of the extracranial arteries is an integral part of the etiologic workup in patients with ischemic stroke. Aortic valve disease shares similar vascular risk profiles and therefore is a common comorbidity in ischemic stroke patients as well as can be an etiologic entity. Aim of this study was to investigate the association between specific doppler curve flow characteristics and the presence of aortic valve disease.

Methods Retrospective, single center analysis of ischemic stroke patients both receiving full nvUS of the extracranial common- (CCA), internal- (ICA) and external carotid artery (ECA) and transthoracic echocardiography (TTE) during their inpatient stay. A rater blinded for the TTE results investigated doppler flow curves for the following characteristics: ‘pulsus tardus et parvus’ for aortic valve stenosis (AS) and ‘bisferious pulse’, ‘diastolic reversal’ and ‘no dicrotic notch’ for aortic valve insufficiency (AI). Predictive value of these doppler flow characteristics were investigated using logistic regression models.

Results From 1320 patients with full examination of doppler flow curves and TTE findings, 75 (5.7%) showed an AS and 482 (36.5%) showed an AI. Sixty-one (4.6%) patients at least showed a moderate to severe AS and 100 (7.6%) at least showed a moderate to severe AI. After adjustment for age, coronary artery disease, arterial hypertension, diabetes mellitus, smoking, peripheral arterial disease, renal failure and atrial fibrillation, the following flow pattern predicted aortic valve disease: 1) ‘pulsus tardus et parvus’ in the CCA and ICA was highly predictive for a moderate to severe AS (OR 1419.5, 95%CI 358.3-5623.4, p<0.001) and 2) ‘no dicrotic notch’ (OR 37.1, 95%CI 4.4-316.8, p=0.001), a ‘bispherious pulse’ (OR 10.2, 95%CI 3.1-33.6, p<0.001) and a ‘diastolic reversal’ (OR 9.6, 95%CI 2-47, p=0.005) in the CCA and ICA predicted a moderate to severe AI. The inclusion of doppler flow characteristics of the ECA did not increase predictive value.

Conclusion Doppler flow characteristics of the CCA and ICA are highly predictive for aortic valve disease. The consideration of these flow characteristics can be useful to streamline diagnostic and therapeutic measures, especially in the out-patient setting.

Publication History

Article published online:
20 June 2022