Ic. Currie et al., DETECTION OF SUBCRITICAL ARTERIAL STENOSES BY HYPEREMIC DOPPLER, European journal of vascular and endovascular surgery, 11(1), 1996, pp. 29-35
Objectives: This study assessed the potential of hyperaemic Doppler to
detect sub-critical stenoses using a flowrig model. Methods: Pulsatil
e flow of a blood substitute was produced in a compliant circuit. A ca
daver carotid artery, constricted by a silk suture produced a variable
, focal stenosis. Forty-seven stenoses were created in five arteries.
Pressure gradients and Doppler measurements were recorded simultaneous
ly across each stenosis at low (200ml/min) and high (400ml/min) flow r
ates. The change in peak velocities between the arterial segment 2cm p
roximal to the stenosis (V1), and the stenotic jet (V2) were used to c
alculate three Doppler indices: (i) V2/V1 ratio, (ii) V2-V1 difference
, (iii) a modified 'Bernoulli' value. A high flow pressure gradient of
greater than or equal to 15% of the resting distal pressure (%Delta P
), represented a significant stenosis. Results: There was improved cor
relation between Doppler indices and %Delta P at high flow (r = 0.87 t
o 0.88) compared to low flow races (r = 0.81 to 0.84). Optimum V2/V1 c
ut off values were determined fry receiver operator characteristic (RO
C) curve analysis. At low flow five sub-critical stenoses were not det
ected (sensitivity 82.8%) yet all but one of these lesions were identi
fied at high flow (sensitivity of 96.6%). The V2-V1 and Bernoulli indi
ces did not improve on the discriminant ability of the V2/V1 ratio. Co
nclusions: The V2/V1 ratio is sensitive to haemodynamic changes at enh
anced flow rates across ideal arterial stenoses. The potential of hype
raemic Doppler to detect sub-critical lesions and so avoid intraarteri
al pressure measurements deserves further in vivo study.