{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:16:57Z","timestamp":1788239817125,"version":"build-2803163510"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The purpose of the study was to evaluate the anterior communicating artery (ACoA) patency in patients with suboptimal temporal bone windows who were scheduled for carotid endarterectomy (CEA), using contrast-enhanced transcranial color-coded real-time sonography (CE-TCCS) combined with common carotid artery compression (CCC) test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>A prospective analysis was conducted on 116 patients with suboptimal temporal bone windows who exhibited symptomatic carotid artery stenosis (sCAS). The display rates of intracranial circle of Willis (CoW) including anterior cerebral artery (ACA), middle cerebral artery, and posterior cerebral artery, were analyzed based on TCCS and CE-TCCS data. The functional patency of the ACoA was assessed by CE-TCCS with and without the CCC test, and the results were compared with the anatomical patency determined by CTA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      The visualization rates of CoW were significantly improved in CE-TCCS (\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). CE-TCCS excluded 24 patients due to unilateral absence of the ACA-A1 segment. We assessed the patency of the ACoA in 92 patients. With CTA as the anatomical reference standard, CE-TCCS combined with CCC test yielded 94.67% sensitivity, 100% specificity and positive predictive value, 80.95% negative predictive value, and 95.65% overall diagnostic accuracy. Compared with CTA, CE-TCCS combined with CCC test showed no significant difference (\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.125) and excellent consistency (Kappa\u202f=\u202f0.868, 95% CI: 0.743\u20130.993,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001), whereas standalone CE-TCCS differed significantly from CTA (\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001) with poor consistency (Kappa\u202f=\u202f0.126, 95% CI: 0.053\u20130.199,\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.013). The functional ACoA patency rate detected by CE-TCCS combined with CCC test was 77.2%, while 70.4% of patent cases were missed by CE-TCCS alone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>CE-TCCS significantly improve the display rate of intracranial CoW. CE-TCCS combined with the CCC test can serve as a reliable technique in preoperative evaluation of ACoA patency in patients with inadequate temporal bone windows.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1806901","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T04:26:53Z","timestamp":1788236813000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The role of contrast-enhanced transcranial color-coded real-time sonography combined with the common carotid artery compression test in preoperative evaluation of anterior communicating artery patency in patients with insufficient temporal bone windows"],"prefix":"10.3389","volume":"17","author":[{"given":"Ying","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuyang","family":"Gan","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sen","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"He","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"41","DOI":"10.23736\/s0392-9590.25.05308-8","article-title":"Medical treatment versus endarterectomy for symptomatic carotid stenosis: systematic review and meta-analysis","volume":"44","author":"Rodrigues","year":"2025","journal-title":"Int Angiol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ejvs.2022.04.011","article-title":"Editor's choice - European Society for Vascular Surgery (ESVS) 2023 clinical practice guidelines on the management of atherosclerotic carotid and vertebral artery disease","volume":"65","author":"Naylor","year":"2023","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1056\/NEJMoa2508800","article-title":"Medical management and revascularization for asymptomatic carotid stenosis","volume":"394","author":"Brott","year":"2026","journal-title":"N Engl J Med"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1007\/s10143-024-03058-9","article-title":"Carotid endarterectomy in the asymptomatic elderly: a systematic review of literature","volume":"47","author":"Roy","year":"2024","journal-title":"Neurosurg Rev"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"3439","DOI":"10.1161\/STROKEAHA.119.026320","article-title":"Associations of perioperative variables with the 30-day risk of stroke or death in carotid endarterectomy for symptomatic carotid stenosis","volume":"50","author":"Knappich","year":"2019","journal-title":"Stroke"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1055\/s-0039-1698441","article-title":"Somatosensory evoked potential and transcranial Doppler monitoring to guide shunting in carotid endarterectomy","volume":"82","author":"Seidel","year":"2021","journal-title":"J Neurol Surg A Cent Eur Neurosurg"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1016\/j.jvs.2011.07.004","article-title":"Updated Society for Vascular Surgery guidelines for management of extracranial carotid disease: executive summary","volume":"54","author":"Ricotta","year":"2011","journal-title":"J Vasc Surg"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1124","DOI":"10.3174\/ajnr.a7570","article-title":"Absence of the anterior communicating artery on selective MRA is associated with new ischemic lesions on MRI after carotid revascularization","volume":"43","author":"Yamashita","year":"2022","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1053\/ejvs.1999.1009","article-title":"The use of preoperative transcranial Doppler variables to predict which patients do not need a shunt during carotid endarterectomy","volume":"19","author":"Visser","year":"2000","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1161\/01.str.31.1.128","article-title":"Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group","volume":"31","author":"Henderson","year":"2000","journal-title":"Stroke"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"110","DOI":"10.2174\/1874192401307010110","article-title":"Preoperative digital carotid compression as a predictor of the need for shunting during carotid endarterectomy","volume":"7","author":"Naraynsingh","year":"2013","journal-title":"Open Cardiovasc Med J"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00000658-191101000-00001","article-title":"Testing the efficiency of the collateral circulation as a preliminary to the occlusion of the great surgical arteries","volume":"53","author":"Matas","year":"1911","journal-title":"Ann Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/0301-5629(86)90138-9","article-title":"Transcranial measurement of blood velocities in the basal cerebral arteries using pulsed Doppler ultrasound: a method of assessing the circle of Willis","volume":"12","author":"Padayachee","year":"1986","journal-title":"Ultrasound Med Biol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1177\/1051228403259274","article-title":"Clinical applications of transcranial color-coded duplex sonography","volume":"14","author":"Krejza","year":"2004","journal-title":"J Neuroimaging"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1901","DOI":"10.1161\/01.str.29.9.1901","article-title":"Transient response harmonic imaging: an ultrasound technique related to brain perfusion","volume":"29","author":"Postert","year":"1998","journal-title":"Stroke"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e250182","DOI":"10.1148\/rg.250182","article-title":"Updates on adult transcranial Doppler, gray-scale, and contrast-enhanced US techniques","volume":"46","author":"Esmeraldo","year":"2026","journal-title":"Radiographics"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"14327","DOI":"10.1021\/acsnano.5c17992","article-title":"New Frontiers in contrast-enhanced ultrasound for Cancer imaging","volume":"20","author":"Berg","year":"2026","journal-title":"ACS Nano"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"224","DOI":"10.26355\/eurrev_202301_30875","article-title":"Application value of transcranial contrast-enhanced ultrasonography in evaluating middle cerebral artery stenosis","volume":"27","author":"Liu","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1148\/radiol.2292030516","article-title":"Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in ultrasound consensus conference","volume":"229","author":"Grant","year":"2003","journal-title":"Radiology"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"3333","DOI":"10.1007\/s11357-023-00896-1","article-title":"Assessment of cerebral autoregulatory function and inter-hemispheric blood flow in older adults with internal carotid artery stenosis using transcranial Doppler sonography-based measurement of transient hyperemic response after carotid artery compression","volume":"45","author":"Magyar-Stang","year":"2023","journal-title":"Geroscience"},{"key":"ref21","first-page":"456","article-title":"Assessment of the collateral function of the circle of Willis: three-dimensional time-of-flight MR angiography compared with transcranial color-coded duplex sonography","volume":"24","author":"Hoksbergen","year":"2003","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"707","DOI":"10.1177\/1358863X241264759","article-title":"Evaluation of collateral circulation in patients with internal carotid artery occlusion: a clinical and ultrasonographic multicenter study","volume":"29","author":"Liu","year":"2024","journal-title":"Vasc Med"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"52","DOI":"10.3174\/ajnr.A4957","article-title":"Collateral assessment by CT angiography as a predictor of outcome in symptomatic cervical internal carotid artery occlusion","volume":"38","author":"Sundaram","year":"2017","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1229","DOI":"10.1016\/j.ultrasmedbio.2009.02.001","article-title":"Inadequate acoustical temporal bone window in patients with transient ischemic attack or minor stroke: role of skull thickness and bone density","volume":"35","author":"Schreuder","year":"2009","journal-title":"Ultrasound Med Biol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"2649","DOI":"10.1016\/j.ultrasmedbio.2019.06.419","article-title":"Transcranial color-coded sonography for the detection of cerebral veins and sinuses and diagnosis of cerebral venous sinus thrombosis","volume":"45","author":"Zhu","year":"2019","journal-title":"Ultrasound Med Biol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1515\/tnsci-2022-0253","article-title":"Assessment of malformations, variations and diameters of vessels forming the circle of Willis - an autopsy study in a non-cerebrovascular cohort","volume":"13","author":"Orosz","year":"2022","journal-title":"Transl Neurosci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1161\/01.str.31.4.920","article-title":"Benefit of echocontrast-enhanced transcranial color-coded duplex ultrasound in the assessment of intracranial collateral pathways","volume":"31","author":"Droste","year":"2000","journal-title":"Stroke"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1007\/s00276-024-03336-7","article-title":"The anterior communicating artery variants: a meta-analysis with a proposed classification system","volume":"46","author":"Triantafyllou","year":"2024","journal-title":"Surg Radiol Anat"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2037","DOI":"10.3174\/ajnr.A4878","article-title":"Comparison of CTA- and DSA-based collateral flow assessment in patients with anterior circulation stroke","volume":"37","author":"Jansen","year":"2016","journal-title":"AJNR Am J Neuroradiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"179","DOI":"10.5853\/jos.2022.02936","article-title":"Collateral circulation in ischemic stroke: an updated review","volume":"25","author":"Maguida","year":"2023","journal-title":"J Stroke"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1007\/s00234-020-02567-w","article-title":"Stroke project of the Spanish cerebrovascular diseases study G. Ultrasonographic and hemodynamic characteristics of patients with symptomatic carotid near-occlusion: results from a multicenter registry study","volume":"63","author":"Palacios-Mendoza","year":"2021","journal-title":"Neuroradiology"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1016\/j.jtcvs.2019.01.105","article-title":"Commentary: functional assessment of circle of Willis-interesting observation or critical consideration?","volume":"158","author":"Etz","year":"2019","journal-title":"J Thorac Cardiovasc Surg"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1093\/jnen\/nlz036","article-title":"Histological differences of the vascular wall between sites with high and low prevalence of intracranial aneurysm","volume":"78","author":"Laarman","year":"2019","journal-title":"J Neuropathol Exp Neurol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1016\/j.neucir.2019.04.002","article-title":"A1 asynchrony, a potential risk factor for the rupture of anterior communicating artery aneurysms: a computational fluid dynamics study","volume":"30","author":"Thenier-Villa","year":"2019","journal-title":"Neurocirugia (Engl Ed)"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1002\/1097-0096(200011\/12)28:9<452::AID-JCU2>3.0.CO;2-6","article-title":"Evaluation of posterior cerebral artery blood flow with transcranial Doppler sonography: value and risk of common carotid artery compression","volume":"28","author":"Jatuzis","year":"2000","journal-title":"J Clin Ultrasound"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.1177\/000331979404501207","article-title":"Compressions of carotid and vertebral arteries in assessment of intracranial collateral flow: correlation between angiography and transcranial Doppler ultrasonography","volume":"45","author":"Hedera","year":"1994","journal-title":"Angiology"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"666","DOI":"10.3389\/fneur.2020.00666","article-title":"Assessment of intracranial collateral circulation using novel TCCS grading system in patients with symptomatic carotid occlusion","volume":"11","author":"Abd-Allah","year":"2020","journal-title":"Front Neurol"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1806901\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T04:26:55Z","timestamp":1788236815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2026.1806901\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":37,"alternative-id":["10.3389\/fneur.2026.1806901"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2026.1806901","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]},"article-number":"1806901"}}