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Vascular Sonography > Extra-cranial Duplex US Examination > Flashcards

Extra-cranial Duplex US Examination Flashcards

1
Q

Transient Ischemic Attacks dont last longer than?

A

24 hours

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2
Q

What are the four symptoms typically associated with carotid artery atherosclerosis?

A
  1. TIA - mini stroke that doesn’t last longer than 24 hours
  2. Reversible ischemic neurologic deficit (RIND) - symptoms are the same as a TIA but last between 24-72 hours
  3. Amaurosis Fugax - temporary painless loss of vision in one or both eyes
  4. Stroke
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3
Q

What should your scale be set to in a carotid exam?

A

20-40 cm/s

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4
Q

What artery are you “tapping” in the temporal tap to determine if you are imaging the ECA?

A

Superficial temporal artery

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5
Q

What portion of what vessel is important in patients at risk for fibromuscular dysplasia?

A

Distal ICA

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6
Q

What gland can be seen superficial to the distal ICA?

A

SMG

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7
Q

What type of waveform is seen in the vertebral artery?

A

Low resistance as it supplies blood to the brain and eyes

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8
Q

From the carotid artery, what transducer movement would be used to image the subclavian artery?

A

Inferior

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9
Q

What type of waveform is seen in the subclavian artery?

A

High resistance as it supplies muscle and not the brain

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10
Q

Arterial velocity measurements should be obtained using an angle of insonation of what range of degrees?

A

45-60 degrees

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11
Q

Where in the carotid arteries does plaque generally form?

A
  1. Carotid bifurcation in the distal CCA
  2. Proximal ICA
  3. Proximal ECA
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12
Q

What abnormality is described as separation of the vessel layers?

A

Arterial dissection - creates a false lumen in which blood from the true lumen can flow

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13
Q

What type of waveform shows a higher forward diastolic flow velocity?

A

Low resistance

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14
Q

What type of waveform shows a lower diastolic flow velocity?

A

High resistance

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15
Q

What percentage of blood from the CCA flows through the ICA?

A

70%

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16
Q

Where are baroreceptors located in the carotid system?

A

Proximal ICA - helps control blood pressure

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17
Q

What adjustment should be considered when imaging the vertebral arteries after the carotid?

A

Decrease the scale for slower flow

18
Q

What type of waveform is seen in the brachiocephalic artery?

A

High resistance flow - triphasic waveform

19
Q

In what arteries will may have severe stenosis in subclavian steal?

A
  1. L subclavian
  2. R brachiocephalic
20
Q

What kind of subclavian steal shows antegrade flow with a deep notch before systole?

A

Hesitant or latent - Stage 1

21
Q

What kind of subclavian steal has “to-and-fro” flow?

A

Bidirectional or alternating - Stage 2

22
Q

What kind of subclavian steal has fully retrograde flow?

A

Complete - Stage 3

23
Q

What type of colour doppler flow is seen that precedes a complete occlusion?

A

“String sign” or “trickle flow”

24
Q

Where are you most likely to see the “string sign” on colour doppler?

A

ICA

25
Q

A severe distal CCA obstruction with continued patency of the carotid bifurcation is often referred to what?

A

A choke lesion - flow may be reversed in the ECA to supply the ICA

26
Q

Doppler waveform with a ICA stenosis vs ICA occlusion? (hint: what may also be seen in the CCA)

A

ICA stenosis - CCA will also appear blunted and resistive

ICA occlusion - CCA takes on features of patent ECA

27
Q

Where does stenosis of the vertebral artery generally occur?

A

Origin of the vessel from the subclavian artery

28
Q

What may be going on with the heart if the waveform appears dampened and has delayed acceleration if there is no stenosis?

A

Low cardiac output or poor EF

29
Q

In what cardiac consideration will you see with “pulsus bisferiens”? (when waveform has two prominent systolic peaks separated by a mid-systolic retraction)

A

Aortic valvular disease or hypertrophic cardiomyopathy

30
Q

What is the ratio used to classify disease of the ICA?

A

ICA (highest PSV from stenosis) /CCA (PSV in normal mid to distal segment)

31
Q

If there is significant stenosis in the origin of the CCA, what will the waveform be like in the distal CCA?

A

Dampened

32
Q

What would the velocity have to be in order to classify a CCA or ECA stenosis as a 50-99% stenosis?

A

200cm/s or greater

33
Q

How do we quantify a vertebral artery stenosis of 50% or greater?

A

V1 - maximum PSV in proximal vertebral artery / V2 - PSV from normal distal vertebral artery

34
Q

Symptoms of a TIA occur on what side of the body in relation to the affected carotid artery causing the symptoms?

A

Opposite side of the body from the TIA

35
Q

Symptoms of amaurosis fugax occurs on what side of the body in relation to the affected carotid artery?

A

The SAME side

36
Q

What transducer movement would you use to go from the CCA to the vertebral arteries?

A

Slide or angle the transducer posteriorly

37
Q

What transducer movement would you use to image the subclavian artery from the neck?

A

Angle inferiorly from the neck

38
Q

T or F? Direct intervention is not possible with a completely occluded ICA?

A

TRUE

39
Q

Doppler parameters are relatively inaccurate for subcategorizing stenoses of less than what percent in terms of diameter reduction?

A

50%

40
Q

T or F? ICA/CCA ratio is valid in the presence of any type of CCA disease?

A

FALSE: is not valid when disease is significant

41
Q

How do we identify a vertebral artery stenosis of 50% or greater?

A
  1. Use V1 - pre-stenosis (max velocity)
    Use V2 - at stenosis (normal distal vertebral artery)

Use V1/V2 ratio. Will be >2.2 if stenosis is present

  1. A vertebral artery PSV of 150cm/s or greater
42
Q

What PSV in the vertebral artery is indicative of stenosis?

A

150cm/s or greater

Vascular Sonography (17 decks)

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