Hemodynamics of subclavian artery stenosis evaluated by multimodal imaging based on vascular ultrasound / 中风与神经疾病杂志

ABSTRACT

@#Objective To investigate the consistency of carotid Doppler ultrasonography （CDU）, computed tomography angiography （CTA）, and digital subtraction angiography （DSA） in the diagnosis of subclavian artery stenosis, as well as the hemodynamic parameters for different degrees of subclavian artery stenosis with DSA as the gold standard. Methods A retrospective analysis was performed for 179 patients who were admitted to Stroke Center of The First Affiliated Hospital of Soochow University from January 2018 to December 2021. CDU, CTA, and DSA were performed within one week, and at least one examination suggested subclavian artery stenosis. The 179 patients were analyzed in terms of the degree of subclavian artery stenosis at both sides. DSA was used as the gold standard to evaluate the degree of subclavian artery stenosis diagnosed by CDU and CTA, and the Kappa consistency analysis was performed for CDU and CTA in evaluating the degree of stenosis. DSA was used as the gold standard for the classification of stenosis degree, and the ROC curve analysis was used to determine the optimal cut-off values of blood flow velocity [peak systolic velocity （PSV） and end-diastolic velocity （EDV）] and blood flow velocity ratio （PSVOR/PSVDIS） in mild stenosis （< 50%）, moderate stenosis （50% ~ 69%）, and severe stenosis （70%~99%）. Results The Kappa consistency analysis showed that CTA had a high consistency with DSA （κ=0.777）, and CDU had a good consistency with DSA （κ=0.813）. With DSA as the standard, the cut-off values of PSV, EDV, and PSVOR/PSVDIS based on CDU were PSV<252 cm/s, EDV<21 cm/s, and PSVOR/PSVDIS<1.9 in the diagnosis of mild stenosis, 252 cm/s≤PSV<339 cm/s, 21 cm/s≤EDV<39 cm/s, and 1.9≤PSVOR/PSVDIS<4.0 in the diagnosis of moderate stenosis, and PSV≥ 339 cm/s, EDV≥39 cm/s, and PSVOR/PSVDIS≥4.0 in the diagnosis of severe stenosis. Conclusion CDU can evaluate the degree of subclavian artery stenosis and hemodynamic changes in a noninvasive, real-time, and dynamic manner and provide a basis for the hierarchical management of clinical precision treatment.