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Intro to Vascular > Week 5 Abnormal carotid / vertebral Scanning > Flashcards

Week 5 Abnormal carotid / vertebral Scanning Flashcards

1
Q

Waveform?

A

triphasic

*3 components of the cardiac cycle (peak systole, early diastole, & end diastole)

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2
Q

waveform?

A

turbulent

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3
Q

waveform?

A

biphasic

  • End diastolic component missing
  • Only the peak systolic & early diastolic components are present
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4
Q

waveform?

A

monophasic

  • Early diastolic & end diastolic components missing
  • Does not cross the baseline
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5
Q

waveform ?

A

laminar

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6
Q

waveform?

A

disturbed

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7
Q

what is Carotid bruit?

A

abnormal sound(s) heard by placing a stethoscope over a vessel

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8
Q

cause of bruit

A
  • skin/tissue/vessel wall vibration
  • diseased, tortuous vessels, or cardiac in origin
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9
Q

most common cause of stenosis

A

atherosclerosis

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10
Q

_____ disease changes the strength of signal

A

proximal

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11
Q

PROXIMAL TO THE STENOS

Proximal to an occlusion or high-grade stenosis, the _____ will increase

A

resistance

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12
Q

PROXIMAL TO THE STENOS In any antegrade diastolic flow proximal to stenosis, if it is present, it may be reduced or absent.

T or F ?

A

T

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13
Q

PROXIMAL TO THE STENOS

Proximal to stenosis pulsatility _______

A

pulsatility decreases

lower pulsatility due to increased resistance

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14
Q

AT THE STENOSIS

______ velocities compared to pre stenotic segment

_______ flow

A

Elevated

Laminar

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15
Q

BEYOND THE STENOSIS *Post stenotic ______ flow (right after the stenosis, not distal to stenosis) ____ broadening ____ of well define spectral edge

A
  1. turbulence or disturbed
  2. Spectral
  3. Loss
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16
Q

4 characteristics of distal stenotic flow:

A
  1. tardus parvus flow 2. prolonged systolic acceleration time 3. low pulsatility 4. dropped velocity
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17
Q

!!!

DISTAL TO THE STENOSIS characteristics

  1. Downstream ______ waveform
  2. prolonged _______
  3. Diminished _______
  4. Velocity should _____ distal to stenosis
A
  1. tardus-parvus *note: Tardus: Slow & late, Parvus: Small & little
  2. Systolic acceleration time
  3. pulsatility
  4. drop off
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18
Q

DISTAL TO THE STENOSIS

  • Downstream tardus-parvus waveform
  • Systolic acceleration time prolonged
  • Acceleration time prolonged
  • Diminished pulsatility
  • Velocity should drop off distal to stenosis

EXCEPT: _______________

A

long stenosis, near occlusive lesions

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19
Q

FLOW WITH PRESENCE OF STENOSIS

site of stenosis?

A

proximal

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20
Q

FLOW WITH PRESENCE OF STENOSIS

site of stenosis?

A

mid

At stenotic lesion

*Note that monophasic, laminar flow

monophasic waveform
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21
Q

FLOW WITH PRESENCE OF STENOSIS

site of stenosis?

A

distal

monophasic waveform with turbulence
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22
Q

waveform very distal to stenosis

A

Tardus Parvus

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23
Q

INTERPRETATION/GRADING STENOSIS

Currently the only published standards are for categorizing _______

A

ICA narrowing

*No published standards to quantify CCA or ECA stenosis (can qualitate them)

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24
Q

INTERPRETATION(ICA): degree of stenosis

ICA PSV >125 cm/s

(in %)

A

>50%

*125 cm/s is a key number

25
Q

INTERPRETATION(ICA): degree of stenosis

ICA PSV >230 cm/s

ICA EDV >100 cm/s

A

≥70 but less than near occlusion

26
Q

INTERPRETATION(ICA): degree of stenosis

If spectral waveforms are normal velocities, but plaque present, according to the criteria by SRU (chart on previous side), it gets reported as ______

A

<50%

27
Q

INTERPRETATION ICA by visual

<15% stenosis by diameter

A

mild

28
Q

INTERPRETATION ICA by visual

>80% stenosis by diameter

A

severe

29
Q

INTERPRETATION ICA by visual

15-50% stenosis by diameter

A

moderate

30
Q

NTERPRETATION ICA by visual

50-80% stenosis by diameter

A

moderately severe

31
Q

INTERPRETATION(ICA): degree of stenosis

ICA EDV >140 cm/s

A

>80% *condition is more severe when EDV increases

32
Q

INTERPRETATION(ICA): degree of stenosis

ICA EDV >140 cm/s

A

>80% *condition is more severe when EDV increases

33
Q

INTERPRETATION(ICA) by waveform

A

<50% diameter diagnosis

34
Q

INTERPRETATION(ICA) by waveform

A

50-74% stenosis

35
Q

INTERPRETATION(ICA) by waveform

A

>75% diameter stenosis

36
Q

3 parameters to assess stenosis

A

PSV

EDV

ICA/CCA ratio

37
Q

_____ is useful in lower classes of stenois but it must/should be used in conjunction with EDV for higher grades of stenosis

A

PSV

38
Q

As narrowing increases, _____ increases because resistance distally is decreasing allowing for flow to come

A

EDV

39
Q

ICA/CCA ratio < ___ is considered within the normal range.

It is an estimate of at least less than 50% stenosis which can be described as no hemodynamically significant stenosis.

A

2.0

40
Q

ICA/CCA ratio

A

comparing the mid CCA PSV to the PSV of the ICA

The peak systolic velocity of the ICA and the peak systolic velocity of the CCA and divide them

*ICA PSV / mid CCA PSV = ICA/CCA ratio; value <2.0 considered normal

41
Q

!!!ICA/CCA ratio of ____ = an approximate 60% stenosis (according to SRU guidelines)

A

3

42
Q

OBSERVATIONS: CCA

  1. Has mixed ______
  2. ____ demonstrates higher velocities due to proximity to the arch
  3. Distal decreases due to the ___________
  4. *Recommended to use the ______sample area for ICA/CCA ratio calculation
A
  1. resistance
  2. Proximal
  3. widening of the bulb area
  4. mid CCA PSV
43
Q

OBSERVATIONS: ICA

  1. Most common site of stenosis is @______
  2. Distal ICA _____ in velocity
A
  1. the take off
  2. increases
44
Q

What is SUBCLAVIAN STEAL SYNDROME?

A

Stenosis or occlusion of the subclavian artery proximal to the takeoff of the vertebral artery

-Severe narrowing of the proximal subclavian artery results in a collateral pathway that ‘steals’ blood from the brain to supply the arm

*shows on the Doppler - retrograde waveform of vertebral artery

45
Q

!!!

SUBCLAVIAN STEAL SYNDROME

Blood will flow down the vertebral coming from the _______ side rather than cross the stenosis and flow upward

A

contralateral

46
Q

SUBCLAVIAN STEAL SYNDROME

  1. More common on the ____ side
  2. Most commonly caused by _____
A
  1. left
  2. atherosclerosis
47
Q

!!!

SUBCLAVIAN STEAL SYNDROME: evaluation approach

  1. Must determine the direction of both vertebral arteries
  2. Early onset of subclavian stenosis may not result in a full reversal of flow, but rather a to-and-fro flow pattern
  3. If retrograde vertebral flow is seen- always check the ____ for increased velocities
  4. May also check bilateral blood pressure _____ mmHG difference from side to side
  5. Treatment: bypass graft from the ____ to the ____
A
  1. subclavian
  2. >15-20
  3. carotid, subclavian

*Note: to-and-fro flow - a continuous or regular movement backward and forward; an alternating movement, flux, flow, etc.

48
Q

!!!

What does this waveform present?

A

mild to moderate stenosis To-and-fro flow pattern: left vertebral artery side of subclavian stenosis- incomplete steal

49
Q

What does this waveform present?

A

Retrograde flow within the left vertebral artery (side of subclavian stenosis)- complete steal

50
Q

Which part of the artery is affected by fibromuscular dysplasia?

A

tunica media

51
Q

What is FIBROMUSCULAR DYSPLASIA?

A

The medial layer (tunica media) of the arterial vessel develops hyperplasia, from increased collagen, and results in a lengthened narrowing- or narrowing that extends for a length of a vessel

52
Q

FIBROMUSCULAR DYSPLASIA

  1. May see ___ sign/____ appearance
  2. Predominance in _____
  3. Common within the ____, bilaterally
  4. Results in ______ velocities
A
  1. string, beaded
  2. females
  3. distal ICA
  4. increased
53
Q

What does the Doppler image present?

A

Color Doppler: swirling of the color within the aneurysm/out pouching PW Doppler: to-and-fro waveform

54
Q

CAROTID ANEURYSM

  1. Widening, dilatation, ballooning of the vessel (___ times larger than its original size)
  2. Caused when portion of the vessel wall weakens
  3. Caused by ____ or _____
A

1.5, trauma, infection

55
Q

DISSECTION

  1. _____ lining elevation resulting in flow appearing as a double lumen
  2. Can be fatal, causing ____ or ______
  3. Can be caused by ____, _____, or unknown
A
  1. Intimal
  2. stroke, asymptomatic
  3. trauma, genetic
56
Q

Carotid Body Tumor

_______ is a tumor that develops between the ICA and ECA

A

Paraganglioma

*Note: Paraganglioma is a type of neuroendocrine tumor that forms near certain blood vessels and nerves outside of the adrenal glands.

57
Q

Carotid Body Tumor

2 characteristics of paraganglioma:

A
  • low malignancy (potential)
  • highly vascular

*can become large and compress on adjacent vessels

58
Q

Management of Carotid Disease

2 modalities:

A

MRI

arteriography

59
Q

Treatment of Carotid Disease

name 2:

A

endarterectomy: surgical removal of part of the inner lining of an artery, together with any obstructive deposits, most often carried out on the carotid artery or on vessels supplying the legs

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Intro to Vascular (17 decks)

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