Carotid artery stenosis

Case contributed by Dr Bruno Di Muzio

Presentation

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

Patient Data

Age: 82
Gender: Male
Ultrasound

Carotid Artery Doppler Ultrasound

Left side:

  • it is observed diffuse thickening of the intima-media complex (> 8.0mm) along the left common carotid. Small soft plaques with a regular surface are seen along the vessel lumen.
  • common carotid artery spectral wave shows an arrhythmic flow with a normal systolic peak value
  • protruding atheromatous plaques in the carotid bulb, predominantly calcified, which cause vascular lumen stenosis. 
  • 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 is swirling flow, observed with colour Doppler mapping.

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

Case Discussion

This patient has total occlusion of the right internal carotid artery and 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 grey-scale and colour 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 disease 1.

See also:

Carotid artery stenosis:  ultrasound criteria

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Case information

rID: 18165
Published: 15th Jun 2012
Last edited: 15th Apr 2018
System: Vascular
Inclusion in quiz mode: Excluded

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