Carotid involvement in aortic dissection diagnosed by duplex scanning

Detection of Carotid Artery Disease by Duplex Ultrasound

Carotid duplex ultrasonography is a common noninvasive technique for evaluating cases of suspected extracranial carotid artery occlusive disease. This manuscript describes the procedure, with an emphasis on positive findings. A review of 16 published studies, totaling 2,168 arteriogram correlations, demonstrates a sensitivity, specificity, and overall accuracy of 95%, 73%, and 91%, respectively, for the detection of stenosis. The ability of the technique to predict the presence of plaque ulceration and intraplaque hemorrhage is less well defined. Carotid duplex ultrasonography is a highly accurate technique for the detection of extracranial carotid artery occlusive disease.

Persistent dissection of carotid artery in patients operated on for type A acute aortic dissection--carotid ultrasound follow-up

Over a period of 5 years, 124 patients were operated on at the National Institute of Cardiology in Warsaw for acute aortic dissection, 27 of whom died. The 97 patients discharged from the hospital were included in the present analysis. The age of the patients ranged from 25 to 73 years with a mean of 50+/-10 years. Ultrasound examination of carotid arteries was performed with the patient lying on his back using a Toshiba 340A color Doppler system with a linear array probe of 7.5 MHz. Of the 97 patients examined, 15 (15%) had a dissection of at least one of the common carotid arteries (CCA). Two had Marfan syndrome. In 11 patients the dissection involved the right common carotid artery and in four it involved both the left and right common carotid arteries. The flow in the true lumen of CCA and ICA was preserved in all patients and the degree of narrowing ranged from 30 to -70%. Only one of the 15 patients with CCA dissection had an ipsilateral neurological deficit which was already present before the aortic aneurysm operation. Ultrasound follow-up was performed in all patients with the CCA dissection found on first examination. The mean duration of follow-up was 21 months. In 14 patients the degree and extent of the dissection as well as the narrowing of the true lumen was comparable, and in one patient the false channel closed spontaneously. During follow-up there were no new major neurological events despite the persistence of the CCA dissection with different degrees of narrowing of the true lumen. Doppler ultrasound examination of the carotid arteries can supply additional information about the extent of the dissection, and help to assess the flow in the persisting 'double channel' common carotid artery during the follow-up of patients.

Internal carotid artery dissection in a patient with Behçet's syndrome

The authors report a case of internal carotid artery dissection in a young woman with Behçet's syndrome. The authors postulate that a vasculitis of the vasa vasorum already suspected as the basis of aneurysm formation in course of Behçet's syndrome can account for occurrence of arterial dissection in this inflammatory condition.

Colour-coded Doppler sonography of common carotid artery dissection

Colour Doppler sonography allowed noninvasive confirmation of bilateral common carotid artery dissection in a patient with previous aortic dissection. It also cast light on the pathophysiology.

Noninvasive monitoring of internal carotid artery dissection

BACKGROUND AND PURPOSE

Internal carotid artery dissection has increasingly been reported as a cause of transient ischemic attack or stroke. However, scarce data exist on the natural history of the arterial lesions and the temporal profile of recanalization.

METHODS

We followed 48 patients with 50 angiographically confirmed internal carotid artery dissections by sequential duplex Doppler studies in 2- to 4-day intervals during the first weeks after the onset of symptoms and after 4 weeks in 1- to 2-month intervals for up to 2 years. We assessed sonographic features as well as the frequency and time course of resolution.

RESULTS

Initial Doppler findings were abnormal in all patients, most of whom (68%) presented with a characteristic bidirectional high-resistance Doppler signal in the internal carotid artery. Gradual recanalization was found in 68% of the dissections after an average interval of 51 days. Changes of Doppler flow patterns in follow-up studies and features of intra-arterial angiography correlated with the development of internal carotid artery dissection and mirrored the recanalization process.

CONCLUSIONS

Our findings suggest that Doppler sonography provides early recognition of internal carotid artery dissection and monitoring of its resolution. Thus, ultrasound studies may guide clinical decisions according to the development of the dissection.

Spontaneous common carotid artery dissection

A case of a symptomatic spontaneous common carotid artery dissection that occurred several months after an ipsilateral carotid endarterectomy is presented. The case was successfully managed with resection of the dissected common carotid artery and placement of an interposition saphenous vein graft. Examination of the specimen demonstrated cystic medial degeneration. Postoperative duplex scans of the carotid artery and graft have been normal. The data obtained from this case and a review of the seven previously reported cases suggest that surgical management of symptomatic spontaneous common carotid artery dissections can be accomplished safely. Surgical management of these dissections is recommended for patients with symptoms and for those without symptoms who have aneurysmal changes in the dissected segment.

Doppler color flow imaging of common carotid artery dissection

Sonographic findings are reported in a case of common carotid artery dissection assessed by Doppler color flow imaging and confirmed by angiography. Advantages and clinical relevance of this new ultrasound method for this diagnosis are discussed.

Duplex scanner study of carotid artery dissection following surgical treatment of aortic dissection type A

In patients suffering from aortic dissection, persistent perfusion of the false lumen distal to the implanted graft is frequent. Postoperative follow-up examinations of the carotid arteries of these patients were performed by duplex scanner and correlated with clinical symptoms. Thirty-nine patients who survived the surgical treatment of acute type A aortic dissection had duplex sonography of both common carotid arteries after an average postoperative follow-up of 53 months. In 21 cases a composite graft and in 18 cases a supracoronary prosthetic vascular graft were implanted. No sign of residual dissection of the common carotid arteries was seen in 23 patients; in nine there was a dissection of both common carotid arteries, and seven patients had a unilateral carotid dissection (five right, two left). There were nine symptomatic patients with the following symptoms: transient ischemic attack (four), amaurosis fugax (four), stroke with incomplete recovery (one). Two symptomatic patients had a corresponding dissection. The generally good prognosis of all these patients suggests a conservative nonoperative treatment.