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DMS 500 Vascular > Lecture 5: Carotid Artery Duplex Imaging > Flashcards

Lecture 5: Carotid Artery Duplex Imaging Flashcards

1
Q

patient history that can indicate a carotid artery scan? (6)

A
  1. neurological symptoms
  2. myocardial infarction
  3. HTN
  4. diabetes
  5. smoking
  6. vascular surgeries
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2
Q

3 scanning positions when scanning carotid

A
  1. anterolateral
  2. lateral
  3. posterolateral
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3
Q

the CCA waveform has elements of both ___ & ___

A

ICA & ECA

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4
Q

what is interpretive criteria for carotid stenosis primarily based on?

A

velocities taken with PW Doppler waveform & waveform analysis

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5
Q

this vessel is low resistance, has continuous forward flow, and no branches in the cervical region

A

ICA

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6
Q

this vessel is high resistance, contains branches in the cervical portion, and responds to the temporal tap

A

ECA

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7
Q

at the posterolateral approach, which branch of the CCA is in the near field and which is in the far field?

A

ICA is in the near field; ECA in far field

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8
Q

this waveform has elements of both ICA & ECA with a sharp upstroke, moderate diastolic flow, and a well-defined dicrotic notch

A

CCA waveform

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9
Q

the waveform of this branch of the carotid is low resistance with broad systolic peaks, substantial diastolic flow, and a dicrotic notch that isn’t well visualized

A

ICA waveform

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10
Q

what is the typical range for PSV for the ICA?

A

54-88 cm/sec

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11
Q

what is considered the abnormal PSV for the ICA?

A

> 100cm/sec
MAX FOR NL <125cm/sec

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12
Q

the waveform for this branch of the CCA is high resistance with a sharp systolic upstroke, little flow in diastole, and a well-visualized dicrotic notch

A

ECA waveform

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13
Q

what is the normal range for PSV in the ECA?

A

77-115 cm/sec
MAX FOR NL <125cm/sec

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14
Q

how does plaque formation start?

A

lipids start infiltrating the tunica intima

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15
Q

progressive accumulation of plaque affects which layers of the arterial walls?

A

initially affects intima; later intima & media

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16
Q

what 3 types of deposits can be found with progressive build up of plaque?

A
  1. fibrotic material
  2. hemorrhagic products
  3. calcifications
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17
Q

how does fibrotic material in plaque show up on ultrasound?

A

hyperechoic but without shadowing

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18
Q

how do hemorrhagic products in plaque show up on ultrasound?

A

depends on age of the blood

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19
Q

how do calcifications in plaque show up on ultrasound?

A

hyperechoic with shadowing

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20
Q

which type of plaque presents with more risk: smooth or irregular?

A

irregular

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21
Q

another name for irregular plaque?

A

ulcerated plaque

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22
Q

why is there an increased risk for ulcerated plaque?

A

there is an increased chance of rupture & erosion of intima

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23
Q

what happens if there is an erosion of the intima?

A

it can break off and be swept away into the brain, leading to a stroke

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24
Q

which type of plaque echogenicity is less cellular in content?

A

low level echogenicity

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25
Q

what risk does low level echogenic plaque pose?

A

there’s an increased risk for ulceration with cerebral ischemic symptoms

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26
Q

which type of plaque echogenicity contains fibrous plaque with collagen?

A

medium level echogenicity

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27
Q

medium level plaque echogenicity poses less risk for cerebral ischemic symptoms if plaque is ____

A

homogenous

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28
Q

why does high level echogenic plaque pose less risk for cerebral ischemic symptoms?

A

plaque is calcified and attached very well to the arterial wall

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29
Q

a normal spectral waveform has a ___ range of velocities in systole & diastole

A

narrow

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30
Q

a normal spectral waveform has an ___ spectral window

A

open

31
Q

PSV of normal spectral waveforms are ___

A

< 125 cm/sec

32
Q

what is the percentage of diameter reduction for a hemodynamically significant stenosis?

A

50-60% diameter reduction

33
Q

a ___ diameter reduction correlates with __ area reduction

A

50% DR; 75% AR

34
Q

what happens to PSV & EDV when there is a 50-60% DR?

A

both increase

35
Q

the pre-stenotic area is considered the area distal to stenosis. T/F?

A

false; it’s the area proximal to stenosis

36
Q

is PSV of a pre-stenotic area normal or abnormal?

A

normal

37
Q

at the stenotic site, what happens to PSV & EDV?

A

both velocities increase

38
Q

spectral broadening doesn’t occur at the stenotic site. T/F?

A

false; it does occur

39
Q

what happens to PSV & EDV at the post-stenotic site?

A

both velocities decrease

40
Q

what type of flow can you expect to see at the post-stenotic site?

A

turbulent

41
Q

what 3 factors influence carotid velocities?

A
  1. cardiac output
  2. blood pressure
  3. obstruction in contralateral CCA
42
Q

what is cardiac output?

A

the amount of blood the left ventricle is ejecting per minute

43
Q

how do you calculate the diameter reduction of a stenosis?

A

go in transverse
DR % = (residual lumen/original lumen)(100)

44
Q

6 categories of stenotic disease?

A
  1. normal
  2. mild
  3. moderate
  4. moderately severe
  5. severe
  6. totally occluded
45
Q

PSV of a normal carotid?

A

< 125 cm/sec

46
Q

what % is considered mild stenosis?

A

1-15%

47
Q

PSV, EDV, and sonic window of mild stenosis?

A

PSV <125 cm/sec
EDV slightly increased
sonic window open

48
Q

what % is considered moderate stenosis?

A

16-49%

49
Q

PSV and sonic window of moderate stenosis?

A

PSV <125 cm/sec
sonic window may or may not be open

50
Q

what is normal ICA/CCA ratio?

A

< 1.5

51
Q

ICA/CCA ratio of moderate stenosis?

A

normal <1.5

52
Q

what % is considered moderately severe stenosis?

A

49-80%

53
Q

PSV of moderately severe stenosis?

A

> 125 cm/sec

54
Q

EDV of moderately severe stenosis?

A

increase but < 105 cm/sec

55
Q

sonic window of moderately severe stenosis?

A

spectral broadening & window filling

56
Q

ICA/CCA ratio of moderately severe stenosis?

A

2.0+

57
Q

what % is considered severe stenosis?

A

80-99%

58
Q

PSV of severe stenosis?

A

80% stenosis = 250+ cm/sec
99% stenosis = 400 cm/sec

59
Q

EDV of severe stensois?

A

> 110 cm/sec

60
Q

ICA/CCA ratio of severe stenosis?

A

5.6+

61
Q

how should you adjust PRF to look for trickle flow/string sign in severe stenosis?

A

lower PRF/scale to increase sensitivity

62
Q

how should you adjust wall filter to look for string sign in severe stenosis?

A

lower wall filter

63
Q

how should you adjust doppler gain to look for trickle flow in severe stenosis?

A

increase doppler gain

64
Q

how should you adjust sample size to look for trickle flow in severe stenosis?

A

increase sample size

65
Q

where should you image in ICA to prove flow with severe stenosis?

A

go as distal as possible

66
Q

use ___ doppler to search for trickle flow in severe stenosis

A

power doppler

67
Q

how can systole & diastole appear in the CCA with total occlusion?

A

systole is shorter with rounded peak
diastole has no flow

68
Q

the CCA waveform with severe proximal stenosis will have a ___ systolic component

A

dampened

69
Q

the CCA waveform with severe proximal stenosis will have ___ flow in diastole

A

forward

70
Q

the CCA waveform with severe proximal stenosis will have ___ pulsatility

A

decreased

71
Q

the CCA waveform with severe distal stenosis will have a ___ systolic portion

A

blunted

72
Q

the CCA waveform with severe distal stenosis will have a ___ diastole

A

absent or decreased

73
Q
A

DMS 500 Vascular (20 decks)

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