Carotid Duplex Flashcards
What should the intimal thickness be for a carotid duplex
> 0.9 mm
_______ ________ will be anechoic or hypoechoic and large in caliber
Acute thrombosis
_______ ________ the vessels will be decreased and will be hypoechoic to echogenic and will have a thumping pattern
Chronic occlusion
What is the normal PW doppler waveform pattern of the ICA
a) low resistance
b) high resistance
a) low resistance
What is the normal PW doppler waveform of the ECA
a) low resistance
b) high resistance
b) high resistance
What is the normal PW doppler waveform on the CCA
a) low resistance
b) high resistance
c) mixed between the 2
c) mixed between the 2
A PSV of ______ cm/s may indicate a hemodynamic significant stenosis
125 cm/s
% diameter reduction is determined by what
EDV
A EDV <140 cm/s = what % diameter reduction
50-79%
An EDV >140 cm/s = what % diameter reduction
80-99%
How do you calculate the ICA/CCA ratio
Take the highest PSV ICA divided by distal CCA
An ICA/CCA ratio of >4.0 = what % diameter reduction
70%
Accelerated flow not related to disease is associated with
a) overestimation of stenosis
b) underestimation of stenosis
a) overestimation of stenosis
1) high cardiac output
2) decreased blood viscosity
3) tortuous vessels
4) compensatory flow changes
are all related to
a) overestimation of stenosis
b) underestimation of stenosis
a) overestimation of stenosis
Dampened flow patterns are associated with
a) overestimation of stenosis
b) underestimation of stenosis
b) underestimation of stenosis
1) proximal stenosis
2) poor cardiac output
3) congestive heart failure
are all related to
a) overestimation of stenosis
b) underestimation of stenosis
b) underestimation of stenosis
When there is an abnormally high resistance with absent diastolic flow where is the disease located
a) proximal
b) distal
b) distal
When there is a dampened tardus parvus like pattern where is the disease located
a) proximal
b) distal
a) proximal
When there is a dampened tardus parvus like pattern unilaterally where is the disease located
proximal
When there is a dampened tardus parvus like pattern bilaterally what is it most likely related to
poor cardiac output
An oscillating or helical pattern ( low velocity and to and fro) indicates
brain death
A proximal/brachiocephalic obstruction or occlusion causing “steal” of blood from vertebrals is called
Subclavian steal’
Which side are subclavian steals more common on
Left side
For a subclavian steal brachial pressures will have how much of a difference
> 20 mmHg
For a subclavian steal the lower pressure is on what side as the disease
a) same
b) opposite
a) same
Retrograde flow in the vertebral artery indicates what
occlusion of ipsilateral proximal subclavian or innominate
Bidirectional vertebral flow (pre-steal) indicates what
stenosis of ipsilateral proximal subclavian or innominate
What is disease is called the pulseless disease
Takayasu arteritis
________ _______ is inflammation of superficial temporal artery
Temporal arteritis
Takayasu arteritis finding is a _____ vessel
donut
Temporal arteritis finding is a _____ inside of vessels
halo
________ _____ can be found 6-24 months post op
Neointimal hyperplasia
While interrogating the proximal ICA during carotid duplex, a PSV of 325cm/s and EDV of 142 cm/s is documented. How would these findings be interpreted?
a) 50-79% DR
b) >75% area reduction
c) >90% DR
d) 80-99% DR
d) 80-99% DR
What could be a likely etiology of dampened waveforms documented in the bilateral CCA’s
a) decreased hemoglobin
b) right sided heart failure
c) poor cardiac output
d) high cardiac output
c) poor cardiac output
The PSV is 282 cm/s and the EDV is 97 cm/s. What is the diameter reduction?
a) 30-49% DR
b) 80-99% DR
c) 50-79% DR
d) >90% DR
c) 50-79% DR
What is the most likely significance of carotid velocities greater than 150 cm/s in both CCA’s
a) poor cardiac output
b) high cardiac output
c) >50% diameter reduction bilaterally
d) carotid hyperemia
b) high cardiac output
- Bilateral flow alterations in the carotids indicate something systemic or cardiac. Accelerated, or higher velocity, flow bilaterally would most likely be caused by high cardiac output. Decreased blood viscosity can also have a similar effect
Which sonographic finding is most consistent with a right subclavian steal?
a) retrograde flow in the left vertebral artery
b) retrograde flow in the right vertebral artery
c) tardus parvus in the right CCA
d) tardus parvus in the right vertebral artery
b) retrograde flow in the right vertebral artery
-Subclavian steal is identified when there is retrograde flow in the ipsilateral (same side) vertebral artery
In the case of vertebral artery occlusion, which vessel is likely to be enlarged
a) ipsilateral ECA
b) contralateral internal mammary artery
c) contralateral vertebral artery
d) ipsilateral subclavian artery
c) contralateral vertebral artery
A 48 year old male presents with retrograde flow in the left vertebral artery. This is most likely related to occlusion of the
a) left subclavian artery
b) right vertebral artery
c) right subclavian artery
d) innominate artery
a) left subclavian artery
A unilateral decrease or absence of diastolic flow in the CCA is indicative of
a) proximal disease of the aortic arch
b) poor cardiac output
c) distal obstructive disease
d) AVF
c) distal obstructive disease
A high resistance flow pattern in the distal portion of the ICA suggests which of the following conditions?
a) Proximal CCA disease
b) Proximal ICA disease
c) Intracranial AV fistula
d) Severe distal ICA stenosis
d) Severe distal ICA stenosis
