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Carotid DissectionAn Actual Case from:
Detroit Medical Center, Harper University Hospital Vascular Lab
Presented By : Angela Bowling
Baker College Of Auburn Hills
Vascular Ultrasound
Winter, 2013
Overview• Carotid Dissection:
• Description
• Typical Symptoms
• Treatment
• Statistics
• Patient Information:
• Demographics
• Symptoms
• History
• Test Ordered
Images:
• Waveform Interpretation
• Hemodynamics
• B-Mode
• Preliminary Report
• Conclusion
Carotid Dissection
• “Hemorrhage within the carotid wall”
• Trauma or Spontaneous
• Intima tears
• Dissecting the carotid artery into two parts
• “True Lumen”
• Usually crowded by false lumen
• “False Lumen”
• Can be patent or thrombosed
• Waveforms typically to/fro flow in false lumen.Rumwell & McPharlin, (2009), Zwiebel & Pellerito, (2005).
www.ispub.com, (2012
Carotid Dissection
• Typical Symptoms:
• Horner syndrome, (drooping eyelid, decreased pupil size)
• “Neck pain, headache, tinnitus, transient monocular blindness”
• Asymptomatic
• Treatment:
• Anticoagulation
• Surgical Stent Zwiebel & Pellerito, (2005)
Rumwell & McPharlin, (2009)
Carotid Dissection
• RARE: In United States: only 2.6 per 100,000
patients.
• How many in this room have scanned a Carotid
Dissection?
Detroit Medical Center, (2012),
Zwiebel & Pellerito, (2005).
Patient Information
• Initials: MJ
• Sex: Female
• Age: 80 years old
• Symptoms: Syncope
• History: • Prior Carotid Aneurysm with Corrective Surgery• Recent Fall down 2 steps due to syncope
• Test Ordered: Bilateral Carotid Study
Detroit Medical Center, (2012).
Images: Waveforms
.
Rumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).
Images: WaveformsRumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).
Images: WaveformsRumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).
Images: HemodynamicsRumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).
Images: HemodynamicsRumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).
Images: B-ModeRumwell & McPharlin, (2009), Detroit Medical Center, (2012),
Zwiebel & Pellerito, (2005).
Preliminary ReportVascular Lab Report
Indication: Syncope
On the right:
Smooth dense plaque visualized in ICA,
PSV of ICA was 74 cm/sec ESV of 26cm/sec
B-mode images and velocities are consistent with 1-39% diameter reduction of the proximal internal carotid artery.
Right Brachial Systolic: 124 mmHg
Left Brachial Systolic: 120 mmHg
Vertebral arteries: appeared to have ante grade flow bilaterally
On the left:
Irregular dense plaque visualized in ICA,
PSV of ICA was 107cm/sec ESV of 27cm/sec
B-mode images and velocities are consistent with 1-39% diameter reduction of the proximal internal carotid artery.
Detroit Medical Center, (2012)
Preliminary Report Continued
On the left, there was a dissection in the mid common carotid
artery visualized.
The velocities pre dissection were 68 cm/sec, and the
velocities post dissection were 228 cm/sec.
There was a clip that was shadowing out a partial area of the
common carotid artery.
Doctor was notified of the results.
Detroit Medical Center, (2012)
Conclusion
• Patient: MJ, 80 year old female
• Symptom: Syncope
• History: Prior carotid aneurysm surgery
Detroit Medical Center, (2012)
Rumwell & McPharlin, (2009) Zwiebel and Pellerito, (2005)
Detroit Medical Center, (2012)
Conclusion• Waveform Interpretation:
Pre-dissection:• Laminar flow with spectral window intact• Moderate pulsatility• Normal PSV of 68 cm/sec
False Lumen:• Reversal of flow : below baseline
Post-dissection: • Turbulent flow with spectral window filled in• Moderate pulsatility• Suggested jet like PSV of 228 cm/sec
• Hemodynamics:• Area of flow separation post dissection (Bernoulli Principle)• Turbulent flow post dissection with mosaic patterns• Retrograde flow in false lumen Detroit Medical Center, (2012)
Zwiebel and Pellerito, (2005)Rumwell & McPharlin, (2009),
Conclusion
• B-Mode Images:
• Plaque visualized ICA Bilaterally
• Left Mid CCA Dissection and clip with shadow
• Suggested findings:
• Left Side Common Carotid Artery Dissection, Clip shadowing
area of dissection.
• 1- 39% stenosis Bilaterally in ICA
• Treatment: Anticoagulation
Detroit Medical Center, (2012)
References
References
Internet Scientific Publications, ISPUB.com (2012) , The Internet Journal of Neurosurgery
(Volume 7 No. 2), www.ISPUB.com
Rumwell, C. & McPharlin, M. (2009). Vascular technology: An illustrated review (4th ed.).
Pasadena, CA: Davies Publishing
Zwiebel, W. & Pellerito, J, (2005). Introduction to vascular ultrasonography (5th ed.).
Philadelphia, PA: Elsevier Saunders
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