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Vascular sonography
Carotid Part 4- Unusual findings and interventional procedures
| Question | Answer |
|---|---|
| If the carotid is tortuous or kinked what should you do? | Do the exam like normal but take the doppler signal in the straighter parts |
| What is a dissection/Intimal Flap? | Separation of the layers of an artery due to intimal tear, Typically intima from media, Intimal flap can flutter in the arterial lumen, Results in creation of false vessel lumen (can have blind end or connect back to true lumen through 2dary tear) |
| False lumen flow pattern variations include? | Antegrade flow due to blood continuing through a secondary tear, Blood flow into and out of the false lumen in a to-&-fro pattern, No flow as thrombus ,ay form thay may create a stenosis or occlusion in the true lumen, Reversed flow direction |
| Where does the dissection/ intimal flap usually originate? | From the Aorta and extend into CCA, May originate in distal ICA and extend proximally |
| Dissections can be what? | Spontaneous or traumatic, Spontaneous often associated with Hx of HTN, Trauma may be subtle (head rotation), or obvious (blunt trauma to head or neck) |
| An intimal flap may occur when? | After carotid endarterectomy (CEA) |
| Dissections/ Intimal Flaps sign and symptoms? | Usually asymptomatic, Head, face or neck pain(usually associated w/ ICA dissection), Hemispheric stroke or TIA symptoms, Dissection should be suspected in young PTs who present with stroke symptoms |
| What are the Duplex findings associated with dissection? | Unusual color flow pattern in an artery that otherwise shows no atherosclerosis, Presence of thin white line in vessel lumen (may flutter with each pulse, should be identified in both Long andTRV planes) |
| What is a blind-ended tear? | True lumen may show low res Doppler signal, If false lumen becomes thrombosed, stenotic flow profiles may be noted in true lumen, False lumen will demonstrate high res flow patterns unless thrombosed, Reverse flow may be noted in the false lumen |
| What are the characteristics of a dissection with secondary tear? | Blood is allowed back into true lumen, True and false lumen may demonstrate antegrade flow, however WF contours may be different |
| What does FMD stand for? | Fibromuscular Dysplasia |
| What is FMD? | Abnormal growth of smooth muscle cells and fibrous tissue in arterial walls, May involve intima, media, &/or adventitia (Media is most common), Can cause narrowing of the arterial lumen in multi sections, "String of beads" app. on arteriography |
| FMD signs and symptoms? | Primarily seen in young white women, Most common location is renal arteries resulting in HTN, ICA is second most common involved vessel (often asymptomatic, Cervical bruit, Emboication may occur and cause TIAs), Diagnosis often confirmed w/angiography |
| What is a Carotid Body Tumor? | Carotid body is a structure in the adventitia of the carotid bifurcation (tumor is often easily seen on duplex sonography) Usually benign, Asymptomatic, PT may notice small lump on anterior neck |
| How does the Carotid Body Tumor present? | As a well defined mass located between the ICA&ECA at bifurcation (causes splaying of the two vessels), Highly vascular tumor, demonstrating a low res WF, Color image should be taken demonstrating mass & vascularity(shows proximity of tumor to ICA&ECA) |
| What is a carotid aneurysm? | Dilation of the carotid artery, True carotid aneurysms are v rare: most commonly occur in the CCA, near bifurcation, Atherosclerosis appears to be the majority cause, May be result of infection |
| What is the clincal presentation of a Carotid Aneurysm? | Nontender, pulsatile mass in neck, Asymptomaic, TIA or stroke symptoms, Rupture is rare |
| How to know if it is a Pseudoaneurysm? | Must be connected by a neck/stalk, Blood flow has a to-and-fro appearance, Swirling flow may be noted within mass |
| Arteritis characteristics? | Inflammation of artery wall, Takayasu & Temporal(giant cell), No definitive ultrasounf characteristics |
| Who does Takayasu usually affect? | Younger people |
| Who does Temporal (Giant cell) usually affect? | Elderly |
| What is a CEA? | Carotid Encarterectomy |
| What happens during a CEA? | Open operation, Arteriotomy is made through ICA, Artheromatous material is removed, Arterioomy is closed (primary closure: arterial wall only, Patch closure: patch is used to enlarge closure area) |
| What are some common problems associated with CEA? | Narrowing as a result of closure, Plaque retained from incomplete excision, Neointimal hyperplasia a surgical site (restenosis) |
| What does CAS stand for? | Carotid artery stenting |
| Is CAS widely used? | No, Complication rates are decreasing, and Low insurance reimbursements |
Created by:
EmilyGriffin
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