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Sonographic Evaluation of Complications of Extracranial Carotid Artery Interventions. Millet John D,Cavallo Joseph J,Scoutt Leslie M,Gunabushanam Gowthaman Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine Carotid endarterectomy and carotid artery stenting are among the most common peripheral vascular procedures performed worldwide. Sonography is the initial and often only imaging modality used in the evaluation of iatrogenic carotid arterial injuries. This pictorial essay provides an overview of the clinical and sonographic findings of complications after interventions in the extracranial carotid arteries, including dissection, fluid collections, pseudoaneurysm, thrombosis, thromboembolism, restenosis, and stent deformation. Grayscale, color, and pulsed Doppler imaging findings are reviewed, and correlations with computed tomography, magnetic resonance imaging, and angiography are provided. 10.1002/jum.14376
Carotid Plaque-RADS: A Novel Stroke Risk Classification System. JACC. Cardiovascular imaging BACKGROUND:Carotid artery atherosclerosis is highly prevalent in the general population and is a well-established risk factor for acute ischemic stroke. Although the morphological characteristics of vulnerable plaques are well recognized, there is a lack of consensus in reporting and interpreting carotid plaque features. OBJECTIVES:The aim of this paper is to establish a consistent and comprehensive approach for imaging and reporting carotid plaque by introducing the Plaque-RADS (Reporting and Data System) score. METHODS:A panel of experts recognized the necessity to develop a classification system for carotid plaque and its defining characteristics. Using a multimodality analysis approach, the Plaque-RADS categories were established through consensus, drawing on existing published reports. RESULTS:The authors present a universal classification that is applicable to both researchers and clinicians. The Plaque-RADS score offers a morphological assessment in addition to the prevailing quantitative parameter of "stenosis." The Plaque-RADS score spans from grade 1 (indicating complete absence of plaque) to grade 4 (representing complicated plaque). Accompanying visual examples are included to facilitate a clear understanding of the Plaque-RADS categories. CONCLUSIONS:Plaque-RADS is a standardized and reliable system of reporting carotid plaque composition and morphology via different imaging modalities, such as ultrasound, computed tomography, and magnetic resonance imaging. This scoring system has the potential to help in the precise identification of patients who may benefit from exclusive medical intervention and those who require alternative treatments, thereby enhancing patient care. A standardized lexicon and structured reporting promise to enhance communication between radiologists, referring clinicians, and scientists. 10.1016/j.jcmg.2023.09.005
Extracranial and transcranial ultrasound assessment in patients with suspected positional 'vertebrobasilar ischaemia'. Sultan M J,Hartshorne T,Naylor A R European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery OBJECTIVES:A diagnosis of 'positional' vertebrobasilar ischaemia is considered in patients presenting with dizziness/vertigo during lateral neck rotation/extension and is attributed to bony 'nipping' of the vertebral artery (VA). This study reviewed our experience with extracranial and transcranial ultrasound to determine whether a diagnosis of 'positional' vertebrobasilar ischaemia was associated with any changes in flow in the extracranial VA and the P1 segment of the posterior cerebral artery (PCA) during head turning. METHODS:A retrospective case note review was undertaken in 46 patients with an accessible window for transcranial Doppler who had undergone extracranial and transcranial assessment of flow velocity and flow directionality in the VA and PCA while the head was moved into positions that normally triggered the patient's symptoms. RESULTS:Positional 'vertebrobasilar symptoms' were triggered by lateral head rotation in 35 patients (76%), while 11 (24%) developed symptoms following neck extension. Only one patient was found to have a significant carotid stenosis (symptoms unchanged following carotid endarterectomy) and none had significant disease in the extracranial VAs. None of the patients exhibited any change in extracranial VA flow during head turning/extension and none had reversal of flow either. Similarly, there was no change observed in the PCA flow characteristics during head turning. The majority of patients (74%) were subsequently referred to the Ear, Nose and Throat (ENT) department, and 94% of the patients noted an improvement in symptoms following entry into a vestibular rehabilitation programme. CONCLUSIONS:A diagnosis of 'positional' vertebrobasilar ischaemia should be made with extreme caution and only after a specialist assessment in a Balance Centre. 10.1016/j.ejvs.2008.12.006
[Evaluating the extracranial cerebral arteries with ultrasound angiography]. Krünes U,Bürger K Ultraschall in der Medizin (Stuttgart, Germany : 1980) AIM:Ultrasound angiography is a new method of colour-coded vessel imaging. The present study aimed at giving further information on its clinical utility in neurosonology. METHOD:The extracranial arteries of 53 patients and 5 normal persons were investigated by ultrasound angiography in comparison with colour-coded duplex sonography. RESULTS:We found a sharper imaging of stenoses and plaques by ultrasound angiography compared with colour Doppler. The imaging of the vessels can be achieved more continuously, avoiding dropouts of the colour. Small vessels and branches can be detected more reality. CONCLUSION:Ultrasound angiography represents a valuable additional imaging technique to colour-coded duplex sonography, providing further information, especially with regard to the border of plaques and stenoses. 10.1055/s-2007-1003991
Early Diagnosis of Intracranial Internal Carotid Artery Stenosis Using Extracranial Hemodynamic Indices from Carotid Doppler Ultrasound. Bioengineering (Basel, Switzerland) Atherosclerotic intracranial internal carotid artery stenosis (IICAS) is a leading cause of strokes. Due to the limitations of major cerebral imaging techniques, the early diagnosis of IICAS remains challenging. Clinical studies have revealed that arterial stenosis may have complicated effects on the blood flow’s velocity from a distance. Therefore, based on a patient-specific one-dimensional hemodynamic model, we quantitatively investigated the effects of IICAS on extracranial internal carotid artery (ICA) flow velocity waveforms to identify sensitive hemodynamic indices for IICAS diagnoses. Classical hemodynamic indices, including the peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistive index (RI), were calculated on the basis of simulations with and without IICAS. In addition, the first harmonic ratio (FHR), which is defined as the ratio between the first harmonic amplitude and the sum of the amplitudes of the 1st−20th order harmonics, was proposed to evaluate flow waveform patterns. To investigate the diagnostic performance of the indices, we included 52 patients with mild-to-moderate IICAS (<70%) in a case−control study and considered 24 patients without stenosis as controls. The simulation analyses revealed that the existence of IICAS dramatically increased the FHR and decreased the PSV and EDV in the same patient. Statistical analyses showed that the average PSV, EDV, and RI were lower in the stenosis group than in the control group; however, there were no significant differences (p > 0.05) between the two groups, except for the PSV of the right ICA (p = 0.011). The FHR was significantly higher in the stenosis group than in the control group (p < 0.001), with superior diagnostic performance. Taken together, the FHR is a promising index for the early diagnosis of IICAS using carotid Doppler ultrasound methods. 10.3390/bioengineering9090422
Does Reduced Carotid Intima Media Thickness Progression Predict Cardiovascular Risk Reduction? Shah Prediman K Circulation 10.1161/CIRCULATIONAHA.120.048890