Presentation
Hospitalized after brain infarct affecting part of the territory of the anterior cerebral artery.
Patient Data
Left side:
- it is observed diffuse thickening of the intima-media complex (> 8.0mm) along the left common carotid. Small soft plaques with a regular surface are seen along the vessel lumen.
- common carotid artery spectral wave shows an arrhythmic flow with a normal systolic peak value
- protruding atheromatous plaques in the carotid bulb, predominantly calcified, which cause vascular lumen stenosis.
- the external carotid artery shows high speeds on systolic peak (v = 426.7 cm / s). Internal carotid artery: high peak systolic velocities (v = 411.7 cm / s). There is swirling flow, observed with color Doppler mapping.
Right side: There is total occlusion of the right internal carotid artery.
Case Discussion
This patient has total occlusion of the right internal carotid artery and hemodynamically significant stenoses in the external carotid artery and left internal carotid.
A ≥70% ICA stenosis but less than near occlusion of the ICA is diagnosed when the ICA PSV is greater than 230 cm/sec, and visible plaque and luminal narrowing are seen at grey-scale and color Doppler US. Additional criteria include ICA/CCA PSV ratio > 4 and ICA EDV > 100 cm/sec. The higher the Doppler parameter lies above the threshold of 230 cm/sec, the greater the likelihood of severe disease 1.
See also:
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