Carotid artery stenosis

Case contributed by Dr Bruno Di Muzio

Presentation

Controlled hypertensive patient, former smoker, neurologically asymptomatic.

Patient Data

Age: 83
Gender: Male
Ultrasound

Carotid Doppler study

Carotid Doppler study demonstrates bilateral atherosclerotic mixed plaques on bulbs (calcified and hypoechoic), being more important on the left, where it is practically subocclusive (near occlusion of the ICA) with higher systolic peaks at 600 cm / s (significant stenosis). On the right, ICA stenosis is lesser than 50%. 

CT

CTA

CT arteriography confirms Doppler findins demonstrating a markedly narrowed lumen of left ICA. Vertebro-basilar system has no hemodynamic repercussions.

MRI

MRA

MRI arteriography shows the same of on CT arteriography, but with low accuracy on this MRI apparatus. No significant findings on brain MRI arteriography. 

Case Discussion

Duplex scan showed a high accuracy in the diagnosis of bilateral ICA stenosis, near of occlusion on the left. The patient went to have an MRI study because of ischemic symptoms after the exam, no new significant finds on brain images and MRA, with these symptoms being reverted, likely representing a TIA. 

CT arteriography showed the same finds with best accuracy for treatment planning. 

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Case information

rID: 28786
Published: 12th Apr 2014
Last edited: 15th Apr 2018
Inclusion in quiz mode: Excluded

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