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Carotid artery stenosis

Case contributed by: Dr Bruno Di Muzio

Presentation:

Hospitalized after ischemic brain affecting part of the territory of the anterior cerebral artery.

Patient Data:

Age: 82
Gender: Male
Race: Asian
From the case: Carotid artery stenosis

Carotid Artery Triplex Ultrasound

Modality: Ultrasound
As institutional protocol, is performed to investigate the causes of cerebral ischemic accident. Doppler US is by far the most common imaging examination performed worldwide to aid in the diagnosis of carotid disease.

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  • It is observed diffuse thickening of the intima-media complex (> 8.0mm) along the left common carotid. Small soft plates with regular surface are see along the vessel lumen.
It is observed diffuse thickening of the intima-media complex (> 8.0mm) along the left common carotid. Small soft plates with regular surface are see along the vessel lumen.

Left side:

1 - It is observed diffuse thickening of the intima-media complex (> 8.0mm) along the left common carotid. Small soft plates with regular surface are see along the vessel lumen.

2 -  Common carotid artery spectral wave shows a arrhythmic flow with with a normal value to systolic peak. 

3 - Protruding atheromatous plaques in the carotid bulb, predominantly calcified, which promote vascular lumen stenosis. 

4 - The external carotid artery shows high speeds on systolic peak (v = 426.7 cm / s). Internal carotid artery: high peak systolic velocities (v = 411.7 cm / s). There are swirling flow, observed by color Doppler mapping.

Right side: There is total obstruction of the right internal carotid artery.

Case Discussion:

This patient had total occlusion of right internal carotid artery, other hemodynamically significant stenoses in the external carotid artery and left internal carotid.

 A ≥70% ICA stenosis but less than near occlusion of the ICA is diagnosed when the ICA PSV is greater than 230 cm/sec and visible plaque and luminal narrowing are seen at gray-scale and color Doppler US. Additional criteria include ICA/CCA PSV ratio > 4 and ICA EDV > 100 cm/sec. The higher the Doppler parameter lies above the threshold of 230 cm/sec, the greater the likelihood of severe disease1.

See also:

Carotid artery stenosis:  ultrasound criteria

References:

  1. 1- Grant EG, Benson CB, Moneta GL et-al. Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003;229 (2): 340-6. doi:10.1148/radiol.2292030516 - Pubmed citation

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