Carotid Artery Stenosis

Thomas F Gudas, MD
Benjamin Faitelson, MD

August 31, 1994

Presentation

Imaging Findings

Images 1 and 2 demonstrate mild wall thickening of the left common (Image 1, with arrow) and internal carotid (Image 2, with arrow) arteries. Normal Doppler spectral waveforms are present. The external carotid artery (ECA) shows low velocity flow in diastole (Image 3, with arrow), indicating a high-impedance circulation. The internal carotid artery (ICA) has high diastolic flow (Image 4, with arrow) associated with low impedance of the cerebral vasculature. Common carotid artery (CCA) is a composite of the internal and external carotid arteries (Image #5). No elevation in the peak systolic (normal < 110 cm/sec) or diastolic (normal < 40 cm/sec) velocities is observed.

Image 6 shows calcific plaque (arrow) with acoustic shadowing in the right carotid bulb. Heterogeneous plaque (Image 7, with arrows) causes significant stenosis of the internal carotid artery. There is elevation of the peak systolic velocity to 255 cm/sec (Image 8, with arrow); this corresponds to an approximate 80% diameter stenosis. The common carotid artery, proximal to the stenosis, demonstrates decreased velocities (Image 9, with arrow) and high resistance.

Differential Diagnosis

Other causes of elevated velocities include hyperdynamic states, aortic valvular lesions, cardiac arrhythmias, and shunting from a contralateral stenosis. The gray-scale images help to avoid misinterpretation. Peak systolic and diastolic ICA/CCA ratios are other reliable parameters.

Diagnosis

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