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Diagnosing Carotid Stenosis by Doppler Sonography

State of the Art

Unit of Ultrasound, Department of Medical Imaging, Rambam Medical Center, Haifa, Israel; and Bruce Rappaport Faculty of Medicine, Israel Institute of Technology, Haifa, Israel.

Address correspondence to Diana Gaitini, MD, Unit of Ultrasound, Department of Medical Imaging, Rambam Medical Center, Ha’aliya 8, PO Box 9602, Haifa 31096, Israel. E-mail: d_gaitini{at}rambam.health.gov.il

Objective. The goal of this review article is to present the state of the art in the clinical applications and technical performance and interpretation of carotid sonographic examinations. Methods. Relevant publications regarding color and duplex Doppler sonography (CDDS) of the carotid arteries extracted from a computerized database (MEDLINE) and from references cited in these articles not appearing on the Internet were reviewed. Results. The ability to quickly and efficiently identify stenosis in the carotid artery is an important goal for clinicians and vascular surgeons. Identification of potentially treatable carotid stenosis enables selection of appropriate candidates for endarterectomy or stent implantation. Advances in performance and interpretation of carotid sonographic studies over the last 20 years have been driven by technological improvements in gray scale and CDDS examinations and have made carotid sonography an important means to reach this goal. On the basis of CDDS, intima-media thickness measurements and plaque location and characterization on gray scale imaging, flow disturbance and areas of stenosis on color Doppler sonography, and flow velocities on spectral Doppler sonography are obtained. The degree of the diameter of a stenosis of the internal carotid artery is the main parameter used for therapeutic approaches. Advantages and limitations of the method are included. Conclusions. Carotid sonography is a unique imaging method for the investigation of carotid abnormalities. Noninvasive, accurate, and cost-effective, it provides morphologic and functional information. It is increasingly becoming the first and often the sole imaging study before endarterectomy, whereas costly and invasive procedures are reserved for special cases.

Key Words: carotid artery stenosis • carotid sonography • Doppler sonography

Abbreviations: ACAS, Asymptomatic Carotid Atherosclerosis Study • CCA, common carotid artery • CDDS, color and duplex Doppler sonography • CEA, carotid endarterectomy • DSA, digital subtraction angiography • ECST, European Carotid Surgery Trial • EDV, end-diastolic velocity • ICA, internal carotid artery • IMT, intima-media thickness • MRA, magnetic resonance angiography • NASCET, North American Symptomatic Carotid Endarterectomy Trial • PSV, peak systolic velocity • SRU, Society of Radiologists in Ultrasound

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