Carotid artery stenosis

Case contributed by Bruno Di Muzio

Presentation

Controlled hypertensive patient, former smoker, neurologically asymptomatic.

Patient Data

Age: 85 years
Gender: Male

Carotid Doppler study

ultrasound

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%. 

CTA

ct

CT arteriography confirms Doppler findings demonstrating a markedly narrowed lumen of left ICA. Vertebro-basilar system is unremarkable.

MRA

mri

MRI arteriography shows the same findings as the CT arteriography, but with less resolution. 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 findings on brain images and MRA, with these symptoms being reverted, likely representing a transient ischemic attack. 

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

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