Carotid duplex MUT

Technique:

Sample volume small __

1-1.5mm

Technique:

Doppler angle __ degrees

45-60

Technique:

NEVER above __ degrees. Must be __ to flow and midstream

60, parallel

Technique:

__ - sag and trans demonstrating presence/absence/severity plaque

b-mode

Technique:

Color: __ patterns/__

turbulent, aliasing

Technique:

__: spectral analysis = quantitative assessment

PW

Technique:

PW: spectral analysis = __ assessment

quantitative

Technique:

vertebral - posterolateral to CCA. Runs between __

transverse processes

Interpretation:

__ - predictor for cardiovascular disease

IMT intima media thickness

Interpretation:

Intimal thickening >__

0.9mm

Plaque classification:

__ - hypoechoic along wall

fatty

Plaque classification:

__ - low to medium level echoes. Overall smooth, even

fibrous/heterogenous

Plaque classification:

__ - mixed. Low/medium/high level echoes all within

complex/heterogeneous

Plaque classification:

__ - all hyperechoic with posterior shadowing. Limits evaluation

calcified

Plaque classification:

__ - crater like

ulcerative

Plaque classification:

__ - oval anechoic area within the plaque

intraplaque hemorrhage

__ - acute will be anechoic or hypoechoic and large caliber

thrombosis

__ - decreased vessel size. Hypoechoic to echogenic. Thumping pattern, piston like horizontal motion

chronic occlusion

PW doppler:

Normal wave forms:

ICA - __

low resistance

PW doppler:

Normal wave forms:

ECA - __

high resistance

PW doppler:

Normal wave forms:

CCA - __

mix between low/high (ECA/ICA)

Interpretation:

PSC > __cm/s may indicate hemodynamic significant stenosis

125

Interpretation:

Main criteria: % diameter reduction(DR) is determined by __

EDV

PSV > 125cm/s = __

maybe stenosis

EDV <__cm/s = 50-79% DR

140

EDV <140cm/s = __% DR

50-79

EDV >__cm/s = 80-99% DR

140

EDV >140cm/s = __% DR

80-99

NASCET AKA __

North America Symptomatic Carotid Endarterectomy Trials

NASCET - North America Symptomatic Carotid Endarterectomy Trials

Highest __, __divided by __ CCA

PSV, ICA, distal

ICA/CCA ratio >/=__ is >/= 70% DR

4.0

ICA/CCA ratio >/=4.0 is >/= __% DR

70

Over or underestimating disease?

• accelerated flow not related to disease

over

Over or underestimating disease?

• high cardiac output > bilateral and throughout

over

Over or underestimating disease?

• decreases blood viscosity > bilateral and throughout

over

Over or underestimating disease?

• tortuous vessels

over

Over or underestimating disease?

• compensatory flow changes

over

Over or underestimating disease?

• dampened flow patterns

under

Over or underestimating disease?

• proximal stenosis

under

Over or underestimating disease?

• poor cardiac output > bilateral and throughout

under

Over or underestimating disease?

• congestive heart failure

under

Indirect indications of the presence of disease

Abnormally __ resistance, absent diastolic

high

Indirect indications of the presence of disease

What does this waveform indicate?

distal occlusion

Indirect indications of the presence of disease

If this waveform is found in the CCA where is the occlusion?

ICA

If possible occlusion is found > use power doppler to eval for __ = near total occlusion

string sign

Indirect indications of the presence of disease

dampened __ like pattern

tardus parvus

If unilateral, where is the disease?

proximal

if bilateral, where is the disease?

poor cardiac output

Indirect indications of the presence of disease

__ or __ pattern = brain death

oscillating or helical

Indirect indications of the presence of disease

Oscillating or helical pattern (low velocity and to-and-fro) = __

brain death

__ - proximal subclavian/brachiocephalic obstruction or occlusion causing “steal’ of blood from vertebrals

subclavian steal

subclavian steal - proximal subclavian/__ obstruction or occlusion causing “steal’ of blood from __

brachiocephalic, vertebrals

subclavian steal findings:

__ flow in vertebral artery = indicated occlusion of ipsilateral prox subclavian or innominate

retrograde (caudal)

Subclavian steal findings:

Retograde (caudal) flow in vertebral artery = indicated __ of __ subclavian or innominate

occlusion, ipsilateral prox

Subclavian steal findings:

__ vertebral flow (presteal) = stenosis of ipsilateral prox subclavian or innominate

bidirectional

Subclavian steal findings:

Bidirectional vertebral flow (presteal) = __ of __ subclavian or innominate

stenosis, ipsilateral prox

__ - usually younger women. Affects larger vessels (may be CCA) “pulseless disease”

takayasu arteritis

Takayasu arteritis finding = __ vessel

donut

__ - inflammation of superficial temporal artery. Patient % headache

temporal arteritis

Termporal arteritis findings = __ inside vessel

halo

Intraoperative:

very high frequency 12-15MHz _ probe

hockey stick

Intraoperative:

during __ - acute defects

• stricture of suture line

• intimal flaps

• platelet aggregation

• residual plaque

carotid endarterectomy

Post procedure surveillance:

immediately post op - __/__

thrombosis/dissections

Post procedure surveillance:

6-24 months - __

neointimal hyperplasia

Post procedure surveillance:

post stenting: stented vessels have normally __ velocities. Up to __cm/s is considered WNL

higher, 225

Post procedure surveillance:

Post stenting - look for signs of __ profile

stenosis