- _skin/tissue/vessel wall vibration_ - diseased, tortuous vessels, or cardiac in origin

!!! DISTAL TO THE STENOSIS characteristics 1. Downstream ______ waveform 2. prolonged _______ 3. Diminished _______ 4. Velocity should _____ distal to stenosis

1. tardus-parvus \ note: Tardus: Slow & late, Parvus: Small & little 2. Systolic acceleration time 3. pulsatility 4. drop off

Week 5 Abnormal carotid / vertebral Scanning Flashcards by Yoshiko Peterson

Waveform?

triphasic

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

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waveform?

turbulent

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waveform?

biphasic

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

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waveform?

monophasic

Early diastolic & end diastolic components missing
Does not cross the baseline

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waveform ?

laminar

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waveform?

disturbed

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what is Carotid bruit?

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

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cause of bruit

skin/tissue/vessel wall vibration
diseased, tortuous vessels, or cardiac in origin

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most common cause of stenosis

atherosclerosis

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_____ disease changes the strength of signal

proximal

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PROXIMAL TO THE STENOS

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

resistance

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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 ?

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PROXIMAL TO THE STENOS

Proximal to stenosis pulsatility _______

pulsatility decreases

lower pulsatility due to increased resistance

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AT THE STENOSIS

______ velocities compared to pre stenotic segment

_______ flow

Elevated

Laminar

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

turbulence or disturbed
Spectral
Loss

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4 characteristics of distal stenotic flow:

tardus parvus flow 2. prolonged systolic acceleration time 3. low pulsatility 4. dropped velocity

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!!!

DISTAL TO THE STENOSIS characteristics

Downstream ______ waveform
prolonged _______
Diminished _______
Velocity should _____ distal to stenosis

tardus-parvus *note: Tardus: Slow & late, Parvus: Small & little
Systolic acceleration time
pulsatility
drop off

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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: _______________

long stenosis, near occlusive lesions

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FLOW WITH PRESENCE OF STENOSIS

site of stenosis?

proximal

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FLOW WITH PRESENCE OF STENOSIS

site of stenosis?

mid

At stenotic lesion

*Note that monophasic, laminar flow

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FLOW WITH PRESENCE OF STENOSIS

site of stenosis?

distal

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waveform very distal to stenosis

Tardus Parvus

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INTERPRETATION/GRADING STENOSIS

Currently the only published standards are for categorizing _______

ICA narrowing

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

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INTERPRETATION(ICA): degree of stenosis

ICA PSV >125 cm/s

(in %)

>50%

*125 cm/s is a key number

**INTERPRETATION(ICA): degree of stenosis** ICA PSV \>230 cm/s ICA EDV \>100 cm/s

≥70 but less than near occlusion

**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 \_\_\_\_\_\_

\<50%

**INTERPRETATION ICA by visual** \<15% stenosis by diameter

mild

**INTERPRETATION ICA by visual** \>80% stenosis by diameter

severe

**INTERPRETATION ICA by visual** 15-50% stenosis by diameter

moderate

**NTERPRETATION ICA by visual** 50-80% stenosis by diameter

moderately severe

**INTERPRETATION(ICA): degree of stenosis** ICA EDV \>140 cm/s

\>80% \*condition is more severe when EDV increases

**INTERPRETATION(ICA): degree of stenosis** ICA EDV \>140 cm/s

\>80% \*condition is more severe when EDV increases

**INTERPRETATION(ICA) by waveform**

\<50% diameter diagnosis

**INTERPRETATION(ICA) by waveform**

50-74% stenosis

**INTERPRETATION(ICA) by waveform**

\>75% diameter stenosis

3 parameters to assess stenosis

PSV EDV ICA/CCA ratio

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

PSV

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

EDV

**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_.

2.0

ICA/CCA ratio

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

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

**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**

1. resistance 2. Proximal 3. widening of the bulb area 4. mid CCA PSV

**OBSERVATIONS: ICA** 1. Most common site of stenosis is @\_\_\_\_\_\_ 2. Distal ICA _____ in velocity

1. the take off 2. increases

What is **SUBCLAVIAN STEAL SYNDROME?**

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

**!!!** **SUBCLAVIAN STEAL SYNDROME** Blood will flow down the vertebral coming from the _______ side rather than cross the stenosis and flow upward

contralateral

**SUBCLAVIAN STEAL SYNDROME** 1. More common on the ____ side 2. Most commonly caused by \_\_\_\_\_

1. left 2. atherosclerosis

!!! 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 \_\_\_\_

3. subclavian 4. \>15-20 5. carotid, subclavian \*Note: **to-and-fro** flow - a continuous or regular movement backward and forward; an alternating movement, flux, flow, etc.

!!! What does this waveform present?

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

What does this waveform present?

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

Which part of the artery is affected by fibromuscular dysplasia?

tunica media

What is FIBROMUSCULAR DYSPLASIA?

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

**FIBROMUSCULAR DYSPLASIA** 1. May see ___ sign/\_\_\_\_ appearance 2. Predominance in \_\_\_\_\_ 3. Common within the \_\_\_\_, **bilaterally** 4. Results in ______ velocities

1. string, beaded 2. females 3. distal ICA 4. increased

What does the Doppler image present?

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

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 \_\_\_\_\_

1.5, trauma, infection

**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

1. Intimal 2. stroke, asymptomatic 3. trauma, genetic

_Carotid Body Tumor_ \_\_\_\_\_\_\_ is a tumor that develops between the ICA and ECA

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

_Carotid Body Tumor_ 2 characteristics of paraganglioma:

* low malignancy (potential) * highly vascular \*can become large and compress on adjacent vessels

_Management of Carotid Disease_ 2 modalities:

MRI arteriography

_Treatment of Carotid Disease_ name 2:

**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 ## Footnote **senting**