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cv > Unit 10: Abnormal Carotid Doppler > Flashcards

Unit 10: Abnormal Carotid Doppler Flashcards

1
Q

What is used as the primary means of indicating % of stenosis?

A

Doppler.

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2
Q

What is the purpose of a carotid duplex exam PW Doppler?

A
  • Identify artery
  • Identify hemodynamically significant obstructions
  • Grade severity of stenosis
  • Document velocity changes across time
  • Document velocity changes across locations in the artery.
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3
Q

What is the doppler flow patterns PRE-STENOSIS?

A
  • Probably normal.
  • High resistance ONLY for very tight distal obstructions or occlusions.
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4
Q

No diastolic flow in the CCA indicates what?

A

An ICA occlusion.

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5
Q

No diastolic flow in proximal ICA indicates what?

A

A distal ICA occlusion.

also known as “carotid siphon occlusion”

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6
Q

What is the doppler signal like AT STENOSIS?

A
  • Abnormal
  • As stenosis increases:
    • Higher velocities caused increase change in frequencies.
    • If stenosis is >50%, psv is atleast 2x pre-stenosis
    • Spectral broadening which indicates non-laminar flow.
    • May have reversed flow under peak.
    • Increased velocity extends into post-stenotic turbulence.
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7
Q

How does the velocity differ with a hemodynamically signficant stenosis?

A

Velocity increases dramatically at 50% diameter stenosis or 75% area stenosis.

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8
Q

How should you measure velocities at a stenosis?

A

Must scroll SV through entire stenosis to fid the highest velocity center stream.

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9
Q

What is the typical velocity found in a stenosis >50%

A

Typically >125 cm/sec.

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10
Q

What is VITAL for accurate grading of stenosis ?

A
  • Find and report the highest velocity center stream in the stenosis.
  • Maintain a true angle with cursor parallel to the walls.
  • Angle 60 degrees or less.
  • Update frequently to be sure to maintain accurate location of SV and angle.
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11
Q

What are the doppler flow patterns post-stenosis?

A
  • Post-stenotic turbulence.
  • Severe spectral broadening
  • Often reversed flow under systolic peak.
  • Feathered downslope
  • High PSV may continue at first and decrease distally.
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12
Q

What should you document in a stenosis?

A

The highest psv and edv in the stenosis.

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13
Q

How many samples should you take in a stenosis for accurate grading?

A

2-3 samples.

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14
Q

What documentation is need to make a diagnosis of a stenosis?

A
  • Must show psv/edv/waveform at pre-stenosis and post-stenosis
  • Must calculate the ICA/CCA ratio.
  • Measure B-mode image in long and transverse
  • Identify all arteries correctly. (include FD in all images that include distal CCA)
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15
Q

If a stenosis is graded 0-19% with a psv <125, what kind of waveform will it yield?

A

No spectral broadening.

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16
Q

If a stenosis is graded 20-49% with a psv <125, what type of waveform will it yield?

A

Some spectral broadening.

17
Q

If a stenosis is graded 50-79% with a psv >125 and a edv of >140, will yield what type of waveform?

A

Turbulence.

18
Q

A stenosis is graded 80-99% with a psv >125 and edv >140, what type of waveform would it yield?

A

Marked turbulence.

19
Q

What does a ICA/CCA ratio of >2.0 signify?

A

>50% diameter stenosis.

20
Q

What does a ICA/CCA ratio of >4.0 signify?

A

70% diameter stenosis.

21
Q

T/F:

We don’t identify stenosis in the vertebral arteries.

A

True.

22
Q

What do we check in the vertebral arteries?

A

Check for the PRESENCE of flow.

23
Q

What must you be careful of when examining the vertebral arteries?

A

Check carefully for flow DIRECTION.

24
Q

What does parvus tardus indicate in a vertebral artery waveform?

A

It indicates a proximal obstruction.

25
Q

What does no edv with good visualization of vertebral indicate in a waveform?

A

Distal obstrucction, probable occlusion.

26
Q

What do you need in order to state a possible occlusion of the vertebral artery?

A

Need a clear image.

27
Q

What are To and Fro flow patterns in the vertebral artery due to?

A

Proximal and distal pressure changes during the cardiac cycle.

28
Q

What can you use to document complete reverse flow on exercise?

A

Post-occlusive reactive hyperemia (PORH)

29
Q

How do you preform a PORH exam?

A
  • Place a pressure cuff on the arm of the affected side.
  • Inflate to 30 mmHg above brachial pressure
  • Hold for 3 minutes
  • Deflate and check vertebral flow direction
  • Pendulum flow may change to all reversed flow.
30
Q

What does a biphasic, monophasic, or extensive turbulence indicate in the SCA?

A

It suggests a proximal obstruction.

31
Q

What should you do to prove a subclavian obstruction ?

A

Take brachial pressure bilaterally.

Must be >20 mmHg difference to be signifcant.

The lowest side has the obstruction.

32
Q

What should you check in order to identify subclavian steal?

A

Check vertebral flow.

33
Q

What is the diagnosis criteria of SSS?

A
  1. Reversed vertebral flow
  2. BP difference >20 mmHg OR abnormal SCA doppler same side.
34
Q
A

cv (16 decks)

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