Is duplex ultrasound a reliable method for evaluating vertebral artery stenosis?

Introduction: Strokes generating from the posterior cerebral circulation represent nearly 25% from the ischaemic acute neurological events and vertebrobasilar insufficiency is a neurologic disorder affecting an increased number of patients. Our study aimed to asses the reliability of doppler ultrasound (DUS) in diagnosing and quantifying vertebral artery stenosis.

Method: A number of 42 patients with clinical evidence of posterior cerebral stroke or vertebrobasilar insufficiency were subject of a retrospective study. Doppler examination was performed in all cases; comparison was made with CT and/or MRI and when available with angiography.

Results: Normal DUS findings were associated in all cases with absence of significant changes in CT or MRI; none of these patients ondergone arteriography. Abnormal DUS pattern suggesting >50% stenosis or „vertebral steal“ syndrome correlated in ˜ 80% cases with pathological findings in CT/MR and was confirmed in all cases where arteriography was performed

Conclusion: Despite technical limitations determined by the performance of the equipment, operator skills and patient particularities (short neck, cervical spine degenerative changes etc), DUS remains, due also to its availability, the first intention method in evaluating extracranial vertebral arteries. A normal study with good visualisation of the vessels has a high negative predictive value and spares more expensive procedures. Abnormal findings consistent with significant stenosis correlated in most cases with CT/MR pattern and was confirmed by arteriography where available.