Carotid ultrasound
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Recent papers in Carotid ultrasound
Objectives External carotid artery (ECA) stenosis is an independent mortality predictor. Additionally, concomitant ECA and internal carotid artery (ICA) stenoses progression has been associated with an increased risk of ipsilateral... more
Objectives
External carotid artery (ECA) stenosis is an independent mortality predictor. Additionally, concomitant ECA and internal carotid artery (ICA) stenoses progression has been associated with an increased risk of ipsilateral ischemic events in asymptomatic patients. Universally accepted ECA duplex velocity criteria, for the prediction of stenosis, do not exist.
Methods
Consecutive patients undergoing angiography and carotid duplex assessments were compared (n=140). ICA, common carotid artery (CCA) and ECA peak systolic velocities (PSV) were recorded. ECA/CCA PSV ratio was calculated. These parameters were compared with angiographic ECA measurements. Receiver-operator curve (ROC) analysis were used to determine optimal criteria in identifying ECA stenosis of >50%.
Results
In patients with little ipsilateral ICA disease, for the detection of ECA stenosis of >50%, an ECA PSV >148 cm/s provided sensitivity 80%, specificity 76.2%, and an overall accuracy of 77.1%. An ECA/CCA PSV ratio of 1.45 demonstrated sensitivity 73.7%, specificity 66.7%, and an accuracy 68.2%.
In patients with ICA stenosis > 50%, for the detection of ECA stenosis of > 50%, an ECA PSV >179 cm/s provided sensitivity 50%, specificity 79.6%, and overall accuracy 71.3%. An ECA/CCA PSV ratio of >1.89 provided sensitivity 71.9%, specificity 72.7%, and overall accuracy 72.5%.
Conclusion
ECA PSV an ECA/CCA PSV ratios appear useful metrics for the prediction of unilateral high-grade ECA stenosis.
External carotid artery (ECA) stenosis is an independent mortality predictor. Additionally, concomitant ECA and internal carotid artery (ICA) stenoses progression has been associated with an increased risk of ipsilateral ischemic events in asymptomatic patients. Universally accepted ECA duplex velocity criteria, for the prediction of stenosis, do not exist.
Methods
Consecutive patients undergoing angiography and carotid duplex assessments were compared (n=140). ICA, common carotid artery (CCA) and ECA peak systolic velocities (PSV) were recorded. ECA/CCA PSV ratio was calculated. These parameters were compared with angiographic ECA measurements. Receiver-operator curve (ROC) analysis were used to determine optimal criteria in identifying ECA stenosis of >50%.
Results
In patients with little ipsilateral ICA disease, for the detection of ECA stenosis of >50%, an ECA PSV >148 cm/s provided sensitivity 80%, specificity 76.2%, and an overall accuracy of 77.1%. An ECA/CCA PSV ratio of 1.45 demonstrated sensitivity 73.7%, specificity 66.7%, and an accuracy 68.2%.
In patients with ICA stenosis > 50%, for the detection of ECA stenosis of > 50%, an ECA PSV >179 cm/s provided sensitivity 50%, specificity 79.6%, and overall accuracy 71.3%. An ECA/CCA PSV ratio of >1.89 provided sensitivity 71.9%, specificity 72.7%, and overall accuracy 72.5%.
Conclusion
ECA PSV an ECA/CCA PSV ratios appear useful metrics for the prediction of unilateral high-grade ECA stenosis.
Introduction A mobile flap associated with plaque rapture is an uncommon entity usually detected incidentally on a carotid scan. There is considerable controversy about the treatment of floating carotid flaps or mobile plaques. We report... more
Introduction
A mobile flap associated with plaque rapture is an uncommon entity usually detected incidentally on a carotid scan. There is considerable controversy about the treatment of floating carotid flaps or mobile plaques. We report a case of a long mobile flap in the Internal Carotid Artery (ICA) that was detected incidentally in a duplex scan.
Case Report
A 88 years old man was admitted from TIA clinic with right hand weakness in the last 24 hours. A carotid duplex study showed irregular heterogeneous atheromatous plaques in Left ICA and a floating flap 1cm long, connected to calcified plaques. The degree of stenosis was <50% bilaterally. MRI showed multiple punctuate foci in Left MCA territory. CTA showed bilateral ICA stenosis 40-50% from calcified plaques. Surgery was decided after patient repeated symptoms and a brittle floating cap was found. The patient presented no complications postoperatively.
Discussion
There are few studies about the pathogenesis and histopathological features of carotid artery mobile lesions. They may be caused by thrombotic substances coming from heart, intimal flap of carotid dissection, unstable atherosclerotic plaque and its mural thrombus. Because of the variability there is controversy about the treatment. Duplex ultrasonography scan is a good method to assess and detect carotid mobile lesions, with high sensitivity and specificity.
Conclusion
Mobile flaps or plaques can be detected incidentally in duplex scan and may present with remarkable variability. Duplex ultrasound is the optimal method of detection
A mobile flap associated with plaque rapture is an uncommon entity usually detected incidentally on a carotid scan. There is considerable controversy about the treatment of floating carotid flaps or mobile plaques. We report a case of a long mobile flap in the Internal Carotid Artery (ICA) that was detected incidentally in a duplex scan.
Case Report
A 88 years old man was admitted from TIA clinic with right hand weakness in the last 24 hours. A carotid duplex study showed irregular heterogeneous atheromatous plaques in Left ICA and a floating flap 1cm long, connected to calcified plaques. The degree of stenosis was <50% bilaterally. MRI showed multiple punctuate foci in Left MCA territory. CTA showed bilateral ICA stenosis 40-50% from calcified plaques. Surgery was decided after patient repeated symptoms and a brittle floating cap was found. The patient presented no complications postoperatively.
Discussion
There are few studies about the pathogenesis and histopathological features of carotid artery mobile lesions. They may be caused by thrombotic substances coming from heart, intimal flap of carotid dissection, unstable atherosclerotic plaque and its mural thrombus. Because of the variability there is controversy about the treatment. Duplex ultrasonography scan is a good method to assess and detect carotid mobile lesions, with high sensitivity and specificity.
Conclusion
Mobile flaps or plaques can be detected incidentally in duplex scan and may present with remarkable variability. Duplex ultrasound is the optimal method of detection
Interventions aimed to prevent cardiovascular diseases (CVD) are more effective if administered to subjects carefully selected according to their CVD risk. Usually, this risk is evaluated on the basis of the presence and severity of... more
Interventions aimed to prevent cardiovascular diseases (CVD) are more effective if administered to subjects carefully selected according to their CVD risk. Usually, this risk is evaluated on the basis of the presence and severity of conventional vascular risk factors (VRFs); however, atherosclerosis, the main pathologic substrate of CVD, is not directly revealed by VRFs. The measurement of the arterial wall, using imaging techniques, has increased the early identification of individuals prone to develop atherosclerosis and to quantify its changes over time.
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
Мета роботи - вивчити взаємозв'язок каротидного атеросклерозу зі змінами вінцевого русла в пацієнтів із стабільною ішемічною хворобою серця. Матеріал і методи. В одноцентровому крос-секційному дослідженні проаналізовано дані обстеження... more
Мета роботи - вивчити взаємозв'язок каротидного атеросклерозу зі змінами вінцевого русла в пацієнтів із стабільною ішемічною хворобою серця.
Матеріал і методи. В одноцентровому крос-секційному дослідженні проаналізовано дані обстеження 129 хворих на стабільну ішемічну хворобу серця (чоловіків - 78 (60,5%), жінок - 51 (39,5%), медіана віку - 64 роки). Усім пацієнтам проводили загальноклінічні, антропометричні, лабораторні обстеження, коронарографію і дуплексне сканування сонних артерій.
Результати. В осіб з обструктивною ішемічною хворобою серця частіше реєструвалися каротидні стенози (84,9% vs 62,8%, p = 0,009), зокрема значущі (25,6% vs 9,3%, p = 0,036). Виявлено також тенденцію до більш високих значень товщини комплексу інтима-медіа загальних сонних артерій у групі хворих з обструктивними ураженнями вінцевого русла, проте вона не досягла рівня статистичної значущості (р = 0,11). Шляхом кореляційного аналізу встановлено прямий зв'язок помірної сили між загальною кількістю каротидних бляшок і величиною Gensini score (r = 0,42), кількістю гемодинамічно вагомих уражень сегментів вінцевих артерій (r = 0,40), а асоціація між товщиною комплексу інтима-медіа каротид та вищеперерахованими показниками стану вінцевого русла була слабкою (r = 0,19). За допомогою багатофакторного логістичного регресійного аналізу визначено незалежні предиктори обструктивного коронарного атеросклерозу: наявність каротидних стенозів (OR: 3,82; 95% CI: 1,42 - 10,3; р = 0,008), чоловіча стать (OR: 4,7; 95% CI: 1,98 - 11,1; р < 0,001), цукровий діабет (OR: 2,76; 95% CI: 1,06 - 7,2; р = 0,037) та інфаркт міокарда в анамнезі (OR: 4,8; 95% CI: 1,34 - 17,2; р = 0,016).
Висновки. Ознаки каротидного атеросклерозу часто спостерігалися в пацієнтів зі стабільною ішемічною хворобою серця, а наявність каротидних бляшок була незалежним предиктором обструктивних змін вінцевого русла, що свідчить про необхідність включення дуплексного сканування сонних артерій в план обстеження вказаної категорії хворих.
The objective of this study was to determine the relationship between carotid atherosclerosis and coronary lesions in patients with stable ischemic heart disease.
Material and methods. We performed a single-center cross-sectional study of 129 patients with stable ischemic heart disease (78 (60.5%) men and 51 (39,5%) women, median age - 64 years). All patients underwent general clinical, anthropometric, laboratory assessment, coronary angiography and carotid duplex ultrasound scanning.
Results. Carotid plaques (84.9% vs 62.8%, p = 0.009), including significant plaques (25.6% vs 9.3%, p = 0.036) were more frequent in patients with obstructive coronary artery disease. Our findings indicated a tendency to greater common carotid artery intima-media thickness in the group of patients with obstructive coronary lesions, however, these changes did not reach the level of statistical significance (p = 0.11). The total number of carotid plaques significantly correlated with the Gensini score (r = 0.42) and the number of stenotic coronary segments (r = 0.40). Association between intima-media thickness and the aforementioned coronary parameters was weak (r = 0.19). By multivariate logistic regression analysis, the independent predictors of obstructive coronary artery disease were the presence of carotid plaques (OR: 3.82, 95% CI: 1.42 - 10.3, p = 0.008), male gender (OR: 4.7; 95% CI: 1.98 - 11.1, p <0.001), diabetes mellitus (OR: 2.76, 95% CI: 1.06 - 7.2, p = 0.037) and history of myocardial infarction (OR: 4,8, 95% CI: 1.34 - 17.2, p = 0.016).
Conclusions. Signs of carotid atherosclerosis were often found in patients with stable ischemic heart disease. The presence of carotid plaques was an independent predictor of obstructive coronary lesions, that's why carotid duplex ultrasound scanning should be included in the examination plan of the given category of patients.
Матеріал і методи. В одноцентровому крос-секційному дослідженні проаналізовано дані обстеження 129 хворих на стабільну ішемічну хворобу серця (чоловіків - 78 (60,5%), жінок - 51 (39,5%), медіана віку - 64 роки). Усім пацієнтам проводили загальноклінічні, антропометричні, лабораторні обстеження, коронарографію і дуплексне сканування сонних артерій.
Результати. В осіб з обструктивною ішемічною хворобою серця частіше реєструвалися каротидні стенози (84,9% vs 62,8%, p = 0,009), зокрема значущі (25,6% vs 9,3%, p = 0,036). Виявлено також тенденцію до більш високих значень товщини комплексу інтима-медіа загальних сонних артерій у групі хворих з обструктивними ураженнями вінцевого русла, проте вона не досягла рівня статистичної значущості (р = 0,11). Шляхом кореляційного аналізу встановлено прямий зв'язок помірної сили між загальною кількістю каротидних бляшок і величиною Gensini score (r = 0,42), кількістю гемодинамічно вагомих уражень сегментів вінцевих артерій (r = 0,40), а асоціація між товщиною комплексу інтима-медіа каротид та вищеперерахованими показниками стану вінцевого русла була слабкою (r = 0,19). За допомогою багатофакторного логістичного регресійного аналізу визначено незалежні предиктори обструктивного коронарного атеросклерозу: наявність каротидних стенозів (OR: 3,82; 95% CI: 1,42 - 10,3; р = 0,008), чоловіча стать (OR: 4,7; 95% CI: 1,98 - 11,1; р < 0,001), цукровий діабет (OR: 2,76; 95% CI: 1,06 - 7,2; р = 0,037) та інфаркт міокарда в анамнезі (OR: 4,8; 95% CI: 1,34 - 17,2; р = 0,016).
Висновки. Ознаки каротидного атеросклерозу часто спостерігалися в пацієнтів зі стабільною ішемічною хворобою серця, а наявність каротидних бляшок була незалежним предиктором обструктивних змін вінцевого русла, що свідчить про необхідність включення дуплексного сканування сонних артерій в план обстеження вказаної категорії хворих.
The objective of this study was to determine the relationship between carotid atherosclerosis and coronary lesions in patients with stable ischemic heart disease.
Material and methods. We performed a single-center cross-sectional study of 129 patients with stable ischemic heart disease (78 (60.5%) men and 51 (39,5%) women, median age - 64 years). All patients underwent general clinical, anthropometric, laboratory assessment, coronary angiography and carotid duplex ultrasound scanning.
Results. Carotid plaques (84.9% vs 62.8%, p = 0.009), including significant plaques (25.6% vs 9.3%, p = 0.036) were more frequent in patients with obstructive coronary artery disease. Our findings indicated a tendency to greater common carotid artery intima-media thickness in the group of patients with obstructive coronary lesions, however, these changes did not reach the level of statistical significance (p = 0.11). The total number of carotid plaques significantly correlated with the Gensini score (r = 0.42) and the number of stenotic coronary segments (r = 0.40). Association between intima-media thickness and the aforementioned coronary parameters was weak (r = 0.19). By multivariate logistic regression analysis, the independent predictors of obstructive coronary artery disease were the presence of carotid plaques (OR: 3.82, 95% CI: 1.42 - 10.3, p = 0.008), male gender (OR: 4.7; 95% CI: 1.98 - 11.1, p <0.001), diabetes mellitus (OR: 2.76, 95% CI: 1.06 - 7.2, p = 0.037) and history of myocardial infarction (OR: 4,8, 95% CI: 1.34 - 17.2, p = 0.016).
Conclusions. Signs of carotid atherosclerosis were often found in patients with stable ischemic heart disease. The presence of carotid plaques was an independent predictor of obstructive coronary lesions, that's why carotid duplex ultrasound scanning should be included in the examination plan of the given category of patients.
Interventions aimed to prevent cardiovascular diseases (CVD) are more effective if administered to subjects carefully selected according to their CVD risk. Usually, this risk is evaluated on the basis of the presence and severity of... more
Interventions aimed to prevent cardiovascular diseases (CVD) are more effective if administered to subjects carefully selected according to their CVD risk. Usually, this risk is evaluated on the basis of the presence and severity of conventional vascular risk factors (VRFs); however, atherosclerosis, the main pathologic substrate of CVD, is not directly revealed by VRFs. The measurement of the arterial wall, using imaging techniques, has increased the early identification of individuals prone to develop atherosclerosis and to quantify its changes over time.
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
B-mode ultrasound is a technique which allows a non-invasive assessment of the arterial wall of peripheral arteries (e.g. extracranial carotid arteries), and provides measures of the intima-media thickness complex (C-IMT) and additional data on the occurrence, localization and morphology of plaques.
Being an independent predictor of vascular events, C-IMT has been considered as a tool to optimize the estimation of CVD risk but this application is still a matter of debate. Though the technique is innocuous, relatively inexpensive and repeatable, its use in the clinical practice is limited by the lack of standardized protocols and clear guidelines.
This review outlines the rationale for the potential use of C-IMT in the stratification of cardio- and cerebro-vascular risk and discusses several topics related to the measurement of this variable, which are still controversial among experts of the field.
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