carotid duplex

Question 1

What are the capabilities of a carotid duplex?

Answer 1

Locating presence of disease,
occlusion vs stenosis,
surface characteristics
% Diameter Reduction

Question 2

What probe is used for a carotid duplex?

Answer 2

7-9MHz High frequency linear array

Question 3

What is the sample volume size of a carotid duplex?

Answer 3

small 1-1.5mm

Question 4

What is the doppler angle for a carotid duplex?

Answer 4

45-60 degrees

Question 5

The doppler angle must be what?

Answer 5

Parallel to flow & midstream for accurate velocity

Question 6

B-mode imaging of a carotid duplex displays what?

Answer 6

Sag & trans images presence/ absence & severity plaque

Question 7

Color image of a carotid duplex displays what?

Answer 7

Turbulent patterns / aliasing

Question 8

Pulse wave / spectral analysis displays what?

Answer 8

measurements

Question 9

What vessels are assessed during a carotid duplex?

Answer 9

CCA, ICA, ECA & VERTEBRAL

Question 10

What does IMT stand for?

Answer 10

Intima media thickness

Question 11

What is IMT?

Answer 11

Predictor for cardiovascular disease

Question 12

What value indicates intimal thickening?

Answer 12

> 0.9mm

Question 13

Fatty plaque sonographic appearance?

Answer 13

Hypoechoic along the wall

Question 14

Fibrous plaque sonographic appearance?

Answer 14

homogenous ( overall smooth even)

Question 15

Complex plaque sonographic appearance?

Answer 15

Heterogenous (mixed)

Question 16

Calcified plaque sonographic appearance?

Answer 16

Hyperechoic w/ posterior shadowing

Question 17

Ulcerative plaque sonographic appearance?

Answer 17

Crater like

Question 18

Intraplaque hemorrhage sonographic appearance?

Answer 18

Oval anechoic w/i the plaque

Question 19

Acute thrombosis on a carotid duplex sonographic appearance?

Answer 19

Anechoic or hypoechoic & large caliber

Question 20

Chronic occlusion on a carotid duplex sonographic appearance?

Answer 20

Decrease vessel size
hypoechoic to echogenic
thumping pattern,
piston horizontal motion

Question 21

Normal ICA waveform

Answer 21

Low resistance

Question 22

Normal ECA waveform?

Answer 22

High resistance

Question 23

Normal CCA waveform?

Answer 23

Mixed b/w high & low resistance

Question 24

PSV > 125cm/s may indicate what?

Answer 24

Possible Hemodynamically significant stenosis

Question 25

Carotid stenosis must also demonstrate what?

Answer 25

All features of a stenosis ( spectral broadening, post stenotic turbulence & altered waveform)

Question 26

Carotid duplex percentage of diameter reduction is determined by what?

Answer 26

EDV

Question 27

Carotid artery EDV < 140cm/s indicates?

Answer 27

50-79% diameter reduction

Question 28

Carotid artery EDV >140cm/s indicates?

Answer 28

80-99% diameter reduction

Question 29

Carotid artery PSV >125CM/S indicates?

Answer 29

Possible stenosis

Question 30

Which ICA is used for ICA/CCA ratio?

Answer 30

Highest PSV ICA

Question 31

Which CCA is used for ICA/CCA ratio?

Answer 31

Distal CCA

Question 32

ICA/ CCA ratio value?

Answer 32

Greater than or equal to 4.0

Question 33

ICA/ CCA ratio greater than or equal to 4.0 indicates?

Answer 33

Greater than or equal to 70% diameter reduction

Question 34

What are the reasons Carotid artery stenosis is over estimated?

Answer 34

Accelerated flow not related to disease. High cardiac output, decrease blood viscosity, tortuous vessels & compensatory flow changes

Question 35

What are the reasons Carotid artery stenosis is underestimated?

Answer 35

Dampened flow patterns, prox stenosis, poor cardiac output & congestive heart failure

Question 36

If the CCA has an abnormally high resistance & absent diastolic this indicates?

Answer 36

ICA occlusion

Question 37

If occlusion is suspected what to do next?

Answer 37

Use power doppler & look for string sign

Question 38

String sign indicates what?

Answer 38

Near total occlusion

Question 39

Dampened tardus parvus waveform in a carotid duplex unilateral means?

Answer 39

Proximal disease

Question 40

Dampened tardus parvus waveform in bilateral CCA means?

Answer 40

Poor cardiac output

Question 41

Dampened tardus parvus waveform in rt CCA means?

Answer 41

Brachiocephalic arterial disease

Question 42

Oscillating aka

Answer 42

helical pattern

Question 43

What does a helical pattern look like?

Answer 43

Low velocity & to & fro bilateral

Question 44

Oscillating waveform indicates?

Answer 44

Brain death

Question 45

When does a subclavian steal occur?

Answer 45

Prox subclavian or brachiocephalic obstruction or occlusion causing steal of blood from vertebrals

Question 46

With subclavian steal vertebral act as a collateral to supply blood where?

Answer 46

To the arm

Question 47

Symptoms of subclavian steal?

Answer 47

VBI symptoms, UE ischemia & brachial pressures with >20mmhg difference.

Question 48

With subclavian steal the side with lower pressure indicates?

Answer 48

Side of disease

Question 49

Most common location for subclavian steal?

Answer 49

Left

Question 50

Retrograde/ caudal flow in the vertebral artery indicates?

Answer 50

Occlusion of ipsilateral prox subclavian or innominate

Question 51

Normal vertebral flow is ?

Answer 51

cephalad/ antegrade

Question 52

With subclavian steal location of occlusion is where?

Answer 52

prox vertebral artery take off

Question 53

Bidirectional flow in a vertebral artery indicates what?

Answer 53

Pre steal

Question 54

Pre- steal means?

Answer 54

Stenosis of ipsilateral prox subclavian or innominate

Question 55

Takayasu sonographic appearance of carotid duplex?

Answer 55

Diminished pulses donut vessel

Question 56

What is temporal arteritis?

Answer 56

Inflammation of superficial temporal artery

Question 57

What is the patient profile for Temporal arteritis?

Answer 57

headache

Question 58

Temporal arteritis sonographic appearance of carotid duplex?

Answer 58

halo inside vessels

Question 59

What probe is used for an intraoperative carotid duplex?

Answer 59

12-15MHz hockey stick probe

Question 60

What are indications of endarterectomy ultrasound?

Answer 60

Acute defects stricture of suture line, intimal flap, platelet aggregation & residual plaque

Question 61

Endarterectomy removes what?

Answer 61

Plaque & intimal lining

Question 62

what are indications immediately post-op endarterectomy ultrasound?

Answer 62

Thrombosis / dissection

Question 63

What are indications of post-stenting ultrasound?

Answer 63

higher velocities

Question 64

What is the normal value for a stented vessel?

Answer 64

Up to 225cm/s