Case Study

Carotid Artery Duplex

  • case-study-carotid-artery-04
  • case-study-carotid-artery-03
  • case-study-carotid-artery-02
  • case-study-carotid-artery-01

Case Narrative

Patient came to her appointment as part of a standard pre-operative evaluation for removal of a uterine myoma. She had a history of stroke with residual slurred speech, making it difficult to understand her. Accordingly, I assumed I would see some carotid stenosis, but her ultrasound showed a stunning 70-99% stenosis in her right internal carotid artery and full occlusion of her left internal carotid artery.

Flow in the common carotid arteries looked fine. The plaque itself in the internal carotid arteries was relatively hypoechoic and not easily visualized in brightness mode, so bidirectional color flow at the proximal internal carotid arteries was surprising. Adding power Doppler allowed me to conclude that there was presence of flow on the right, though minimal, and absolutely no flow in the left internal carotid artery.

Upon completion of the exam, I called the ER and spoke with the doctor, who asked me to bring Rose to the ER. Unfortunately, due to the location of the right internal carotid artery stenosis in the bony canal and total occlusion of the left internal carotid artery, surgery was not an option for clearing out the carotid plaque, but doctors believed she could continue functioning well with collateral vasculature carrying blood to her brain.

Thankfully, the patient passed her other pre-operative tests, consented to her surgery, and underwent general anesthesia with no complications. An 8-cm mass was removed from her uterus and her prognosis is good.

Featured Course

Vascular Interpretation Preceptorship
This Vascular Interpretation Preceptorship combines up to 3 days of in-person lecture, discussion and collaborative learning, with access to our library of over 500 vascular cases for interpretation and assessment. VIEW TRAINING COURSE

Case Study Details

Patient Information
A 49 year old Hispanic female.
History
History of stroke two years ago with residual dysarthria and right hemiparesis.
Exam Performed
Carotid Duplex
Study Summary
The patient came to her appointment at the Vascular Lab as part of a standard pre-operative evaluation.
Critical Learning
Utilizing power Doppler to discern occlusion from near-occlusion.
Outcome/Diagnosis
Ultrasound diagnosis: 70-99% right internal carotid artery stenosis and left internal carotid artery occlusion. Surgery cannot be performed on an occluded internal carotid artery. Correlating with the ultrasound, CT diagnosed Rose with a 99% right internal carotid artery stenosis and 100% left internal carotid artery occlusion. CT of her brain showed only an old left frontal lobe infarct, consistent with her right hemiparesis.

Due to the location of the right internal carotid artery stenosis in the bony canal and full occlusion of the left internal carotid artery, the physician concluded that carotid surgery was not an option for the patient, but expressed that she is likely to continue functioning due to collateral flow around her carotid arteries.

Tell Us Your Story

We want to hear how you are using Ultrasound to improve patient care. Email Us Your Story