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Carotid duplex ultrasound
Jenelle Beadle March, 2015
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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
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Position/technique Patient Position Supine Head angled to the side
Rolled towel under neck Position adjusted to optimize sonographic window
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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
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Exam protocol Protocol will be available on Sharepoint
Written and Image formats Protocol still needs to be approved to be made official
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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
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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
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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
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*Image at the most proximal, straight segment
CCA Proximal Trans
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CCA Proximal Long
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CCA Proximal Color Doppler
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CCA Proximal Spectral Doppler
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*2-3cm below the bifurcation
CCA Distal Trans Transducer: 6-15MHz
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CCA Distal Long
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CCA Distal Color Doppler
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CCA Distal Spectral Doppler
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CCA Spectral Analysis:
EDV should be above zero EDV should be similar to the contralateral CCA, taken at approximately the same level
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Bifurcation Trans (bulb)
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Bifurcation Trans (just above bulb)
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*Look for branches ECA Prox Long
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ECA Prox Color Doppler
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ECA Prox Spectral Doppler
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ECA Spectral Analysis Higher resistance than the ICA PSV normally greater ICA Sharp upstroke Prominent dicrotic notch (may reverse) EDV approach/reach zero
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*Include bulb ICA Prox Long
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*Obtained just below the bulb where vessel is no longer dilated
ICA Prox Color Doppler
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*Waveform may reflect flow disturbances of the bulb extending into the prox ICA
ICA Prox Spectral Doppler
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ICA Mid Color Doppler
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ICA Mid Spectral Doppler
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ICA Dist Color Doppler
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ICA Dist Spectral Doppler
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ICA Spectral Analysis Low resistance Continuous forward flow EDV well above zero
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Vertebral Color Doppler
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Vertebral Spectral Doppler
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Vertebral Spectral Analysis
Low resistance Slightly more resistive than the ICA Antegrade, bidirectional, retrograde
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*Sampled close to the origin
Subclavian Color Doppler
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Subclavian Spectral Doppler
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Subclavian Spectral Analysis
High resistance Reversal late systole/early diastole
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Repeat on left
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Online form PSV EDV PSV
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Tips/tricks
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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
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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
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Branches = ECA
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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
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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
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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
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Vertebral Origin Most common location for stenoses
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Not required unless pathology is suspected
CCA Subclav Innominate Not required unless pathology is suspected
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Innominate Not required unless pathology is suspected
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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
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Lowered Color Frequency
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Increase Color Gain
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Decreased Steer Box Angle
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By making x3 adjustments
After Before
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