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9 - Conventional carotid Doppler ultrasound

from Luminal imaging techniques

Published online by Cambridge University Press:  03 December 2009

By
Gregory Moneta
Edited by
Jonathan Gillard ,
Martin Graves ,
Thomas Hatsukami  and
Chun Yuan
Gregory Moneta
Affiliation:
Oregon Health and Science University, Portland, OR, USA
Jonathan Gillard
Affiliation:
University of Cambridge
Martin Graves
Affiliation:
University of Cambridge
Thomas Hatsukami
Affiliation:
University of Washington
Chun Yuan
Affiliation:
University of Washington
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Summary

Introduction

This chapter provides an overview of the traditional and evolving criteria used for grading carotid artery stenosis as well as the clinical relevance of sonography in the management of symptomatic and asymptomatic carotid disease. Additionally, discussions of carotid restenosis after endarterectomy as well as the diagnostic difficulties imposed by internal carotid coils and kinks, bilateral high-grade carotid stenosis and carotid stenting are included.

Technical points

Brachial systolic and diastolic blood pressures are measured in each arm. The carotid duplex ultrasound examination includes the carotid and vertebral arteries bilaterally, as stipulated by vascular laboratory accrediting organizations. Because the flow characteristics in one carotid artery may be influenced significantly by the status of the contralateral carotid artery, it is important to perform bilateral carotid examinations. A very high-grade stenosis or occlusion of one common or internal carotid artery can result in increased compensatory flow in the opposite vessel (Fujitani et al., 1992). The velocity readings in the patent artery therefore are higher than expected and may suggest a greater degree of stenosis than is actually present.

The ultrasound examination should include both longitudinal and transverse views of the vessels. Vessel diameter measurements, visual assessment of stenosis severity, and plaque assessments should be done in the transverse plane. Doppler waveforms should be generated from the longitudinal plane. Gray-scale images alert the examiner to the presence of plaque in the arterial wall, while changes in the hue of the color flow pattern suggest the presence of stenosis.

Type
Chapter
Information
Carotid Disease
The Role of Imaging in Diagnosis and Management
 , pp. 105 - 125
Publisher: Cambridge University Press
Print publication year: 2006

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References

Abou-ZamZam, A. M. Jr , Moneta, G. L., Edwards, J. M., et al. (2000). Is a single preoperative duplex scan sufficient for planning bilateral carotid endarterectomy?Journal of Vascular Surgery, 31, 282–8.CrossRefGoogle ScholarPubMed
AbuRahma, A. F., Robinson, P. A., Stickler, D. L., et al. (1998). Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials. Annals of Vascular Surgery, 12, 349–58.CrossRefGoogle ScholarPubMed
Alexandrov, A. V., Brodie, D. S., McLean, A., et al. (1997). Correlation of peak systolic velocity and angiographic measurement of carotid stenosis revisited. Stroke, 28, 339–42.CrossRefGoogle ScholarPubMed
Beebe, H. G., Salles-Cunha, S. X., Scissons, R. P., et al. (1999). Carotid arterial ultrasound scan imaging: A direct approach to stenosis measurement. Journal of Vascular Surgery, 29, 838–44.CrossRefGoogle ScholarPubMed
Block, R. W. and Lusby, R. J. (1992). Carotid plaque morphology and interpretation of echolucent lesion. Diagnostic Vascular Imaging, 225–36.Google Scholar
Bluth, E. I., Stavros, A. T., Marich, K. W., et al. (1988). Carotid duplex sonography: A multicenter recommendation for standardized imaging and Doppler criteria. Radiographics, 6, 487–506.CrossRefGoogle Scholar
Browman, M. W., Cooperberg, P. L., Harrison, P. B., et al. (1995). Duplex ultrasonography criteria for internal carotid stenosis of more than 70% diameter: Angiographic correlation and receiver operating characteristic curve analysis. Canadian Association of Radiology Journal, 46, 291–5.Google ScholarPubMed
Busuttil, S. J., Franklin, D. P., Youkey, J. R., et al. (1996). Carotid duplex overestimation of stenosis due to severe contralateral disease. American Journal of Surgery, 172, 144–8.CrossRefGoogle ScholarPubMed
Carpenter, J. P., Lexa, F. J. and Davis, J. T. (1995). Determination of 60% or greater carotid artery stenosis by duplex Doppler ultrasonography. Journal of Vascular Surgery, 22, 697–703.CrossRefGoogle ScholarPubMed
Carpenter, J. P., Lexa, F. J. and Davis, J. T. (1996). Determination of duplex Doppler ultrasound criteria appropriate to the North American symptomatic carotid endarterectomy trial. Stroke, 27, 695–9.CrossRefGoogle ScholarPubMed
Colhoun, E. and Macerlean, D. (1984). Carotid artery imaging using duplex scanning and bi-directional arteriography: A comparison. Clinical Radiology, 35, 101–6.CrossRefGoogle Scholar
Comerota, A. J., Katz, M. L., White, J. V., et al. (1990). The pre-operative diagnosis of the ulcerated carotid atheroma. Journal of Vascular Surgery, 11, 505–10.CrossRefGoogle Scholar
Derdeyn, C. P. and Powers, W. J. (1996). Cost-effectiveness of screening for asymptomatic carotid artery disease. Stroke, 27, 1944–50.CrossRefGoogle Scholar
Edwards, J. M., Moneta, G. L., Papanicolaou, G., et al. (1995). Prospective validation of a new duplex ultrasound criteria for 70%–99% internal carotid stenosis. Journal d'Echographie et de Médecine Ultrasonore, 16, 3–7.Google Scholar
Effeney, D. J., Ehrenfeld, W. K., Stoney, R. J., et al. (1979). Fibromuscular dysplasia of the internal carotid artery. World Journal of Surgery, 3, 179.CrossRefGoogle ScholarPubMed
Eikelboom, B. C., Ackerstaff, R. G., Ludwig, J. W., et al. (1983). Digital video subtraction angiography and duplex scanning in assessment of carotid artery disease: Comparison with conventional angiography. Surgery, 94, 821–5.Google ScholarPubMed
El-Barghouty, N., Geroulakos, G., Nicolaides, A., et al. (1995). Computer assisted carotid plaque characterization. European Journal of Vascular and Endovascular Surgery, 9, 389–93.CrossRefGoogle Scholar
Fillinger, M. F., Baker, R. J. Jr , Zwolak, R. M., et al. (1996). Carotid duplex criteria for a 60% or greater angiographic stenosis: Variation according to equipment. Journal of Vascular Surgery, 24, 856–64.CrossRefGoogle ScholarPubMed
Fujitani, R. M., Mills, J. L., Wang, L. M. and Taylor, S. M. (1992). The effect of unilateral internal carotid arterial occlusion upon contralateral duplex study: Criteria for accurate interpretation. Journal of Vascular Surgery, 16, 459–67.CrossRefGoogle ScholarPubMed
Goes, E., Janssens, W., Maillet, B., et al. (1990). Tissue characterization of atheromatous plaques: Correlation between ultrasound image and histological findings. Journal of Clinical Ultrasound, 18, 611–17.Google ScholarPubMed
Grant, E. G., Benson, C. B., Moneta, G. L., et al. (2003). Carotid artery stenosis: Gray-scale and Doppler us diagnosis — society of radiologists in ultrasound consensus conference (online). Radiology, 19, 190–8.
Grant, E. G., Duerinckx, A. J., El Saden, S., et al. (1999). Doppler sonographic parameters for the detection of carotid stenosis. American Journal of Roentgenology, 172, 1123–9.CrossRefGoogle ScholarPubMed
Grant, E. G., Duerinckx, A. J., El Saden, S. M., et al. (2000). Ability to use duplex Ultrasound to quantify internal carotid stenoses: Fact or fiction?Radiology, 214, 247–52.CrossRefGoogle ScholarPubMed
Gray-Weale, A. C., Graham, J. C., Burnett, J. R., et al. (1988). Carotid artery atheroma: comparison of pre-operative B-mode ultrasound appearance with carotid endarterectomy specimen. Journal of Cardiovascular Surgery, 29, 115–23.Google Scholar
Griewig, B., Morganstern, C., Driesner, F., et al. (1996). Cerebrovascular disease assessed by color flow and power Doppler ultrasonography. Comparison with digital subtraction angiography in internal carotid artery stenosis. Stroke, 27, 95–100.CrossRefGoogle Scholar
Groschel, K., Riecker, A., Schulz, J. B., et al. (2005). Systematic review of early recurrent stenosis after carotid angioplasty and stenting. Stroke, 36, 367–73.CrossRefGoogle ScholarPubMed
Hayes, A. C., Johnson, K. W., Baker, W. H., et al. (1988). The effect of contralateral disease on carotid Doppler frequency. Surgery, 103, 19–23.Google ScholarPubMed
Hood, D. B., Mattos, M. A., Mansour, A., et al. (1996). Prospective evaluation of new duplex criteria to identify 70% internal carotid artery stenosis. Journal of Vascular Surgery, 23, 254–61.CrossRefGoogle ScholarPubMed
Howard, G., Baker, W. H., Chambless, L. E., et al. (1996). An approach for the use of Doppler ultrasound as a screening tool for hemodynamically significant stenosis (despite heterogeneity of Doppler performance). A multicenter experience. Asymptomatic carotid atherosclerosis study investigators. Stroke, 27, 1951–7.CrossRefGoogle ScholarPubMed
Hunink, M. G., Polak, J. F., Barlan, M. M., et al. (1993). Detection and quantification of carotid artery stenosis: Efficacy of various Doppler velocity parameters. American Journal of Roentgenology, 160, 619–25.CrossRefGoogle ScholarPubMed
Huston, J. 3rd, James, E., Brown, R. D. Jr, et al. (2000). Redefined duplex ultrasonographic criteria for the diagnosis of carotid artery stenosis.Mayo Clinic Proceedings, 75, 1133–40.
Kuntz, K. M., Polak, J. F., Whittermore, A. D., et al. (1997). Duplex ultrasound criteria for the identification of carotid stenosis should be laboratory specific. Stroke, 28, 597–602.CrossRefGoogle ScholarPubMed
Lal, B. K., Hobson, R. W. II, Goldstein, J., et al. (2004). Carotid artery stenting: Is there a need to revise ultrasound velocity criteria?Journal of Vascular Surgery, 39, 58–66.CrossRefGoogle Scholar
Lennihan, L., Krupsky, W. J., Mohr, J. P., et al. (1987). Lack of association between carotid plaque hematoma and ischemic cerebral symptoms. Stroke, 18, 879–81.CrossRefGoogle ScholarPubMed
Lovelace, T. D., Moneta, G. L., Abou-ZamZam, A. M. Jr , et al. (2001). Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%. Journal of Vascular Surgery, 33, 56–61.
Mattos, M. A., Bemmelen, P. S., Barkmeier, I. D., et al. (1993). Routine surveillance after carotid endarterectomy: Does it affect clinical management?Journal of Vascular Surgery, 17, 819–30.CrossRefGoogle ScholarPubMed
Moneta, G. L., Edwards, J. M., Chitwood, R. W., et al. (1993). Correlation of North American Symptomatic Carotid Endarterectomy Trial (North American symptomatic carotid endarterectomy trial): Angiographic definition of 70% to 90% internal carotid artery stenosis with duplex scanning. Journal of Vascular Surgery, 17, 152–9.CrossRefGoogle Scholar
Moneta, G. L., Edwards, J. M., Papanicolaou, G., et al. (1995). Screening for asymptomatic internal carotid artery stenosis: Duplex criteria for discriminating 60% to 99% stenosis. Journal of Vascular Surgery, 21, 989–94.CrossRefGoogle ScholarPubMed
Neale, M. L., Chambers, J. L., Kelly, A. T., et al. (1994). Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American symptomatic carotid endarterectomy trial and the European trial and the European carotid surgery trial. Journal of Vascular Surgery, 20, 642–9.CrossRefGoogle ScholarPubMed
Nehler, M. R., Moneta, G. L., Lee, R. W., et al. (1996). Improving selection of patients with less than 60% asymptomatic internal carotid stenosis for follow-up carotid artery duplex scanning. Journal of Vascular Surgery, 24, 580–5.CrossRefGoogle ScholarPubMed
Perkins, J. M., Galland, R. B., Simmons, M. J., et al. (2000). Carotid duplex imaging: Variation and validation. British Journal of Surgery, 87, 320–2.CrossRefGoogle Scholar
Pross, C., Shortsleeve, C. M., Baker, J. D., et al. (2001). Carotid endarterectomy with normal findings from a completion study: Is there need for early duplex scan?Journal of Vascular Surgery, 33, 963–7.CrossRefGoogle ScholarPubMed
Ranke, C., Creutzig, A., Becker, H., et al. (1999). Standardization of carotid ultrasound: A hemodynamic method to normalize for interindividual and interequipment variability. Stroke, 30, 402–6.CrossRefGoogle Scholar
Roederer, G. O., Langlois, Y. E., Chan, A. T., et al. (1982). Ultrasonic duplex scanning of the external carotid arteries: Improved accuracy using new features from the carotid artery. Journal of Cardiovascular Ultrasonography, 1, 373–80.Google Scholar
Roederer, G. O., Langlois, Y. E., Jager, K. A., et al. (1989). A simple spectral parameter for accurate classification of severe carotid artery disease. Bruit, 3, 174–8.Google Scholar
Roth, S. M., Back, M. R., Bandyk, D. F., et al. (1999). A rational algorithm for duplex scan surveillance after carotid endarterectomy. Journal of Vascular Surgery, 31, 838–9.Google Scholar
Sarkari, N. B. and Bickerstaff, E. R. (1973). Neurological manifestations associated with internal carotid loops and kinks in children. Journal of Neurology, Neurosurgery and Psychiatry, 33, 194.CrossRefGoogle Scholar
Soulez, G., Therasse, E., Robillard, P., et al. (1999). The value of internal carotid systolic velocity ratio for assessing carotid artery stenosis with Doppler sonography. American Journal of Roentgenology, 172, 207–12.CrossRefGoogle ScholarPubMed
Srinivasan, J., Mayberg, M. R., Weiss, D. G., et al. (1995). Duplex accuracy compared with angiography in the veteran affairs cooperative studies trial for symptomatic carotid stenosis. Neurosurgery, 36, 648–53.CrossRefGoogle ScholarPubMed
Stanziale, S. F., Wholey, M. H., Boules, T. N., et al. (2005). Determining in-stent stenosis of carotid arteries by duplex ultrasound criteria. Journal of Endovascular Therapy, 12, 346–53.CrossRefGoogle ScholarPubMed
Strandness, D. E. Jr. (1990). Duplex Scanning in Vascular Disorders. New York: Raven Press, pp. 92–120.Google Scholar
Umemura, A. and Yamada, K. (2000). B-mode flow imaging of the carotid artery. Stroke, 32, 2055–7.CrossRefGoogle Scholar
Everdingen, K. J. and Kapelle, L. J. (1998). Overestimation of a stenosis in the internal carotid artery by duplex sonography caused by an increase in flow volume. Journal of Vascular Surgery, 27, 479–85.CrossRefGoogle Scholar

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