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Carotid duplex ultrasound

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Presentation on theme: "Carotid duplex ultrasound"— Presentation transcript:

1 Carotid duplex ultrasound
Jenelle Beadle March, 2015

2 indications Cerebrovascular Accident (CVA)
Transient Ischemic Attacks (TIA) Cervical Bruit Pulsatile Mass Less Specific Symptoms Dizziness Headaches Pre-operative Post-operative Monitor known carotid arterial disease

3 Position/technique Patient Position Supine Head angled to the side
Rolled towel under neck Position adjusted to optimize sonographic window

4 Position/technique Patient Position Supine Head angled to the side
Rolled towel under neck Position adjusted to optimize sonographic window Technique Highest frequency, penetrating transducer Keep angle at 60 degrees Diagnostic Criteria Reproducibility 3-5 cycles/waveform Waveform 2/3 of image Lower baseline Decrease scale

5 Exam protocol Protocol will be available on Sharepoint
Written and Image formats Protocol still needs to be approved to be made official

6 Exam protocol Protocol will be available on Sharepoint
Written and Image formats Protocol still needs to be approved to be made official Scan Assistant protocol has been set up in accordance with written protocol Protocol will also be set up on Siemens machine at SH

7 Exam protocol Protocol will be available on Sharepoint
Written and Image formats Protocol still needs to be approved to be made official Scan Assistant protocol has been set up in accordance with written protocol Protocol will also be set up on Siemens machine at SH Examine all accessible portions of the CCA/ICA Basic assessment of the ECA/Vert/Subcl

8 Exam protocol Protocol will be available on Sharepoint
Written and Image formats Protocol still needs to be approved to be made official Scan Assistant protocol has been set up in accordance with written protocol Protocol will also be set up on Siemens machine at SH Examine all accessible portions of the CCA/ICA Basic assessment of the ECA/Vert/Subcl Protocol is designed to be the minimal required images Additional images will often be necessary when the exam is normal Additional images will always be necessary when pathology is encountered

9 *Image at the most proximal, straight segment
CCA Proximal Trans

10 CCA Proximal Long

11 CCA Proximal Color Doppler

12 CCA Proximal Spectral Doppler

13 *2-3cm below the bifurcation
CCA Distal Trans Transducer: 6-15MHz

14 CCA Distal Long

15 CCA Distal Color Doppler

16 CCA Distal Spectral Doppler

17 CCA Spectral Analysis:
EDV should be above zero EDV should be similar to the contralateral CCA, taken at approximately the same level

18 Bifurcation Trans (bulb)

19 Bifurcation Trans (just above bulb)

20 *Look for branches ECA Prox Long

21 ECA Prox Color Doppler

22 ECA Prox Spectral Doppler

23 ECA Spectral Analysis Higher resistance than the ICA PSV normally greater ICA Sharp upstroke Prominent dicrotic notch (may reverse) EDV approach/reach zero

24 *Include bulb ICA Prox Long

25 *Obtained just below the bulb where vessel is no longer dilated
ICA Prox Color Doppler

26 *Waveform may reflect flow disturbances of the bulb extending into the prox ICA
ICA Prox Spectral Doppler

27 ICA Mid Color Doppler

28 ICA Mid Spectral Doppler

29 ICA Dist Color Doppler

30 ICA Dist Spectral Doppler

31 ICA Spectral Analysis Low resistance Continuous forward flow EDV well above zero

32 Vertebral Color Doppler

33 Vertebral Spectral Doppler

34 Vertebral Spectral Analysis
Low resistance Slightly more resistive than the ICA Antegrade, bidirectional, retrograde

35 *Sampled close to the origin
Subclavian Color Doppler

36 Subclavian Spectral Doppler

37 Subclavian Spectral Analysis
High resistance Reversal late systole/early diastole

38 Repeat on left

39 Online form PSV EDV PSV

40 Tips/tricks

41 Long ECA/ICA Two for the price of one Satisfies the Long ICA & Long ECA B-mode requirements; do not have to do x2 separate images

42 Long ECA/ICA Two for the price of one Satisfies the Long ICA & Long ECA B-mode requirements; do not have to do x2 separate images

43 Branches = ECA

44 Tap on superficial temporal artery ant/sup to ear Indicates ECA
Temporal Tap Tap on superficial temporal artery ant/sup to ear Indicates ECA Not reliable

45 Even w/ normal pts, you can get a + temp tap in the ICA
In pt’s w/ a significant stenosis of the ECA, results of temp tap may be - in ECA & + in ICA

46 Bulb “ICA Prox” Widened portion of the proximal ICA Disturbed flow Unidirectional along the flow divider of the birfurcation Zero/reversed flow at outer wall

47 Vertebral Origin Most common location for stenoses

48 Not required unless pathology is suspected
CCA Subclav Innominate Not required unless pathology is suspected

49 Innominate Not required unless pathology is suspected

50 Image quality Distal ICA can be difficult to demonstrate
Prox/Mid ICA Doppler settings are not adequate to optimize the distal ICA adjustments must be made

51 Lowered Color Frequency

52 Increase Color Gain

53 Decreased Steer Box Angle

54 By making x3 adjustments
After Before


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