Carotid Artery

ultrasound scanning protocol for carotid arteries

Carotid Arteries Assess: Carotid lumen CCA / ICA / ECA Vessell patency Vessell orientation Blood haemodynamics (spectral pattern) CCA / ICA / ECA Plaque morphology (echogenic, hypoechoic, mixed, calcification, indeterminate) Surface of plaque (smooth, irregular, indeterminate) Bifurcation (normal, high, low) Tortuosity (minimal, moderate, maximum) technical quality (poor, good, excellent) vertibral artery flow direction Documentation: Longitudinal view Proximal ICA: B-mode / colour Doppler Proximal ECA: B-mode / colour Doppler Mid CCA: B-mode / colour Doppler Spectral trace Distal CCA (1cm from bifurcation, unless bulb extends into CCA, there is distal CCA disease or patient build prevents an accurate distal measurement: then sample in the mid CCA) ECA proximal ICA proximal / mid / distal If stenosis is found document degree of stenosis with spectral trace pre / mid / distal stenosis dynamic clip stores as required

Carotid Stenosis grading Diameter Reduction Peak Systolic Vel Ratio 0 – 49% <2 50 – 69% > 2 ≤ 3 70 – 89% > 3 < 5 ≥ 90% ≥ 5 Occluded No Flow Detected Where a stenotic lesion causes a reduction in the arterial diameter in excess of 95%, the flow velocities measured across this will plateau or even fall resulting in a falsely reduced PSVR and possibly, an under estimation of the severity of the stenosis. In this situation, as indeed at all times, one must pay particular attention the appearance of and changes in flow velocity wave forms proximal and distal to a lesion. Similarly any other spectral, colour or B-Mode cues that may support decisions to assign specific degrees of stenosis based on PSVR values should also be employed.

Post - OP carotid endarectomy assessment Assess: Fibro-intimal hyperplasia Progression of proximal or distal disease Dissection vein patch Documentation: As in stnadard carotid scan with images labelled " POST-OP CEA"

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