Carotid artery stenosis: Difference between revisions
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If there is doubt whether the narrowing is still patent (open to blood flow) and the patient is to be assessed for treatment, the next imaging option would either be [[computed tomography]] [[angiogram]] (CTA) or a [[magnetic resonance imaging]] angiogram (MRA). | If there is doubt whether the narrowing is still patent (open to blood flow) and the patient is to be assessed for treatment, the next imaging option would either be [[computed tomography]] [[angiogram]] (CTA) or a [[magnetic resonance imaging]] angiogram (MRA). | ||
MRA takes much longer to complete, more costly and not yet as widely available. | MRA takes much longer to complete, more costly and not yet as widely available. | ||
Revision as of 16:18, 1 October 2012
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| Carotid artery stenosis | |
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| ICD-10 | I65.2 |
| ICD-9 | 433.1 |
| DiseasesDB | 31178 |
| MeSH | D016893 |
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Carotid artery stenosis Microchapters |
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Diagnosis |
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Treatment |
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ACC/AHA Guideline Recommendations |
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Periprocedural Management of Patients Undergoing Carotid Endarterectomy |
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Atherosclerotic Risk Factors in Patients With Vertebral Artery Disease |
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Occlusive Disease of the Subclavian and Brachiocephalic Arteries |
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Case Studies |
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Carotid artery stenosis On the Web |
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American Roentgen Ray Society Images of Carotid artery stenosis |
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Risk calculators and risk factors for Carotid artery stenosis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Diagnosis
If there is doubt whether the narrowing is still patent (open to blood flow) and the patient is to be assessed for treatment, the next imaging option would either be computed tomography angiogram (CTA) or a magnetic resonance imaging angiogram (MRA).
MRA takes much longer to complete, more costly and not yet as widely available.
Ultrasound Criteria for Carotid Artery Stenosis
- Normal:
- ICA PSV is less than 125 cm/sec and no plaque or intimal thickening is visible sonographically.
- Additional criteria include ICA/CCA PSV ratio < 2.0 and ICA EDV < 40 cm/sec.
- <50% ICA stenosis:
- ICA PSV is less than 125 cm/sec and plaque or intimal thickening is visible sonographically.
- Additional criteria include ICA/CCA PSV ratio < 2.0 and ICA EDV < 40 cm/sec.
- 50%–69% ICA stenosis:
- ICA PSV is 125–230 cm/sec and plaque is visible sonographically.
- Additional criteria include ICA/CCA PSV ratio of 2.0–4.0 and ICA EDV of 40–100 cm/sec.
- >=70% ICA stenosis but less than near occlusion
- ICA PSV is greater than 230 cm/sec and visible plaque and luminal narrowing are seen at gray-scale and color Doppler US (The higher the Doppler parameter lies above the threshold of 230 cm/sec, the greater the likelihood of severe disease).
- Additional criteria include ICA/CCA PSV ratio > 4 and ICA EDV > 100 cm/sec.
- Vear occlusion of the ICA:
- Velocity parameters may not apply, since velocities may be high, low, or undetectable.
- Diagnosis is established primarily by demonstrating a markedly narrowed lumen at color or power Doppler US (35).
- Total occlusion of the ICA
- No detectable patent lumen at gray-scale US and no flow with spectral, power, and color Doppler US. [1]
Cardiac MRI
ACC/AHA Guidelines- ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance[2] (DO NOT EDIT)
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CMR may be used for defining the location and extent of carotid arterial stenoses. |
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Treatment
Options for treatment include:
- Conservative: Antiplatelet drug
- Carotid endarterectomy (surgical removal of the atheroma)
- Carotid stenting
Examples
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See also
References
- ↑ Edward G. Grant, Carol B. Benson, Gregory L. Moneta, Andrei V. Alexandrov, J. Dennis Baker, Edward I. Bluth, Barbara A. Carroll, Michael Eliasziw, John Gocke, Barbara S. Hertzberg, Sandra Katanick, Laurence Needleman, John Pellerito, Joseph F. Polak, Kenneth S. Rholl, Douglas L. Wooster, and Eugene Zierler. Carotid Artery Stenosis: Gray-Scale and Doppler US Diagnosis—Society of Radiologists in Ultrasound Consensus Conference. Radiology published online September 18, 2003.
- ↑ American College of Cardiology Foundation Task Force on Expert Consensus Documents. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA; et al. (2010). "ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents". Circulation. 121 (22): 2462–508. doi:10.1161/CIR.0b013e3181d44a8f. PMC 3034132. PMID 20479157.