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Vascular II > Carotid Grading > Flashcards

Carotid Grading Flashcards

1
Q

Critical stenosis is a (3)

A

Hemodynamically significant reduction in volume, pressure and flow

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2
Q

What % of the cross-sectional area must be encroached upon before there’s a reduction in distal pressure & flow in the AORTA versus the carotid

A

Aorta: 90% reduction cross sectional area
Carotid: 70-90% reduction

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3
Q

Plaque morphology: what does homogenous vs heterogenous vs calcified vs ulcerated suggest

A

Homogenous - acute
Heterogenous - longer
Calcified - chronic
Ulcerated - a piece broken off

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4
Q

T/F - power Doppler does not show aliasing however it helps delineate low flow

A

True

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5
Q

How do you adjust parameters to demonstrate low flow? (2)

A

Lower velocity scale & colour gain

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6
Q

Stenosic zone SOUND

A

High pitched whistling (higher velocity)

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7
Q

Post-stenotic turbulence SOUND

A

Garbled sound

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8
Q

Distal stenosis SOUND

A

Low pitch, weaker amplitude

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9
Q

Complete occlusion SOUND

A

Thumping

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10
Q

What is the normal carotid intima media thickness (CMIT) measure?

A

<0.9 mm

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11
Q

What do you document when a stenosis is found (4)

A

1- Proximal stenosis sample
2- Within stenosis: measure PSV & EDV (highest velocity recorded 2-3 times).
3- After stenosis: document post-stenotic turbulence
4- Distal tardus parvus waveform

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12
Q

What is the PSV ratio measurement?
What does the ratio indicate as it increases?
When is this useful?

A
  • PSV stenosis/PSV ICA
  • The higher the ratio, the greater the stenosis (directly proportional relationship)
  • Useful when velocities are globally low (i.e. decreased heart function)
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13
Q

A MILD stenosis: ____% diameter reduction

A

Mild: 20% diameter reduction

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14
Q

A MODERATE stenosis: ____% diameter reduction

A

MODERATE: 20-50% diameter reduction

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15
Q

A MODERATELY SEVERE stenosis: ___% diameter reduction

A

MODERATELY SEVERE: 50-80%

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16
Q

A SEVERE stenosis: ___% diameter reduction

A

SEVERE: >80% diameter reduction

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17
Q

Total occlusion is

A

No residual lumen to measure

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18
Q

Difference between calculating DIAMETER reduction vs. AREA reduction

A

Diameter:
longitudinal view + hemeodynamically significant lesions >50% diameter reduction

Area:
Transverse view + hemodynamically significant lesions >75% area reduction

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19
Q

What is the FORMULA for calculating % stenosis for area/diameter reduction?

A

= 1 - (residual/original) * 100

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20
Q

Systolic Acceleration Time (AT) or

RISE TIME is the

A

Onset of systole to peak systole (ms)

21
Q

The rise time in the renal arteries should be less than ____

A

70 ms

22
Q

NASCET Criteria:

<15% stenosis traits

A

Deceleration spectral broadening

< 125 cm/s PSV

23
Q

NASCET Criteria:

16-49% ICA Stenosis traits

A

Pansystolic spectral broadening

<125 cm/s PSV

24
Q

NASCET criteria:

50-69% stenosis

A 
Pansystolic spectral broadening
PSV >125 cm/s
EDV <110 cm/s 
OR
ICA/CCA PSV ratio between 2-4
25
Q

NASCET criteria

70-79% stenosis

A 
Pansystolic spectral broadening
PSV >270 cm/s
OR
EDV >110 cm/s
OR
ICA/CCA ratio >4
26
Q

NASCET Criteria

80-99% stenosis

A

EDV > 140 cm/s

27
Q

Patient HISTORY (6)

A 
Previous stroke
Smoker
Elevated BP
Hyperlipidemia
Diabetic
Family Hx of any above
28
Q

INDICATIONS (7)

A 
Headaches
Bruit
Present stroke
TIA
Vertigo/dizziness
A autos is fagax
Limb weakness
29
Q

When are carotid BRUITS most COMMON? When are they most SEVERE?

A

Common: With increasing stenosis and maximal at 70-90% stenosis

Severe: If pt has ipsilateral bruit, diabetes, or previous TIA

30
Q

*DIFFERENTIAL DIAGNOSIS of a carotid bruit (7)

A
  • Murmur radiating from stenosis ao valve
  • ECA disease
  • Intraluminal turbulence ICA
  • Arteriovenous malformations
  • External compression from thoracic outlet syndrome
  • Scarring due to neck surgery
  • Tumour
31
Q

If the ICA/CCA ratio is 2 or more, then what 3 things occur?

A

There is a hemodynamically significant stenosis, meaning
1- the velocity doubles from CCA to ICA
2- the PSV of the ICA is > 125 cm/s
3- the ratio is 2 or more

32
Q

How do you measure the ICA/PSV ratio?

A

Proximal ICA PSV/Distal CCA PSV

33
Q

What is a CEA?

A

Carotid endarterectomy

A surgical procedure that removes plaque / blockage in lining of artery

34
Q

*When is a CEA recommended?

A

If the patient is symptomatic and >70% narrowing of artery

35
Q

How is calcified plaque delineated on the technical impression

A

Xxxxxx

36
Q

What is TRICKLE FLOW also referred to as?

A

Pre-occlusive flow

37
Q

With trickle flow, how would you adjust the parameters? (3)

A

Decrease PRF
Increase colour gain
Increase sample volume size to lumen width

38
Q

COLLATERAL flow examples (3)

A

1- OA direction in setting of high grade/complete occlusion of ICA
2- reversed VA flow and brachial artery systolic pressures in setting of SSS
3- Reversed ECA flow in setting of CCA occlusion

39
Q

Document changes in flow patters if the ICA is occluded (5)

A

1- Lower resistant with high flow “internalization” (because flow is now going into the ICA)
2- Post stenotic turbulence to stenosis (PST)
3- turbulent prox CCA flow in setting of INN A or LT SCA stenosis
4- Tardus parvus waveform distal to high grade stenosis
5- High resistant CCA prox to ICA stenosis

40
Q

When does externalization of the CCA happen?

A

Occlusion ICA, retrograde flow in stump of ICA, absence of flow in the ICA and beyond

41
Q

You should always include image of prox ICA demonstrating colour outline of _____ plaque

A

Soft plaque

42
Q

The term for a longer area of calcified plaque

How does this affect flow versus a shorter area of plaque?

A

Sessile

43
Q

Is angle correct necessary for the opthalmic artery?

A

No, only the direction of flow is important

44
Q

When do you use a straight colour box? (2)

A

Tortuous vessels

Imaging vessel in TRV

45
Q

POST STENOTIC TURBULENCE waveform

A

Loss of sharp upstroke
Jagged peak
Flow above and below the baseline simultaneously

46
Q

When you’re assessing OA, what parameters do you change? (2)

A

Lower PRF

Remove angle correct

47
Q

OA reversed flow suggests what (2)

A

ICA occluded or high grade stenosis

Normally ICA feeds the OA, but if it’s occluded, then ECA will feed OA

48
Q

What plaques are the most dangerous and why?

A

Hypo/echolucent - most likely to break off

Vascular II (22 decks)

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