Carotid DissectionAn Actual Case from:

Detroit Medical Center, Harper University Hospital Vascular Lab

Presented By : Angela Bowling

Baker College Of Auburn Hills

Vascular Ultrasound

Winter, 2013

Overview• Carotid Dissection:

• Description

• Typical Symptoms

• Treatment

• Statistics

• Patient Information:

• Demographics

• Symptoms

• History

• Test Ordered

Images:

• Waveform Interpretation

• Hemodynamics

• B-Mode

• Preliminary Report

• Conclusion

Carotid Dissection

• “Hemorrhage within the carotid wall”

• Trauma or Spontaneous

• Intima tears

• Dissecting the carotid artery into two parts

• “True Lumen”

• Usually crowded by false lumen

• “False Lumen”

• Can be patent or thrombosed

• Waveforms typically to/fro flow in false lumen.Rumwell & McPharlin, (2009), Zwiebel & Pellerito, (2005).

www.ispub.com, (2012

Carotid Dissection

• Typical Symptoms:

• Horner syndrome, (drooping eyelid, decreased pupil size)

• “Neck pain, headache, tinnitus, transient monocular blindness”

• Asymptomatic

• Treatment:

• Anticoagulation

• Surgical Stent Zwiebel & Pellerito, (2005)

Rumwell & McPharlin, (2009)

Carotid Dissection

• RARE: In United States: only 2.6 per 100,000

patients.

• How many in this room have scanned a Carotid

Dissection?

Detroit Medical Center, (2012),

Zwiebel & Pellerito, (2005).

Patient Information

• Initials: MJ

• Sex: Female

• Age: 80 years old

• Symptoms: Syncope

• History: • Prior Carotid Aneurysm with Corrective Surgery• Recent Fall down 2 steps due to syncope

• Test Ordered: Bilateral Carotid Study

Detroit Medical Center, (2012).

Images: Waveforms

.

Rumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).

Images: WaveformsRumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).

Images: WaveformsRumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).

Images: HemodynamicsRumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).

Images: HemodynamicsRumwell & McPharlin, (2009), Detroit Medical Center, (2012), Zwiebel & Pellerito, (2005).

Images: B-ModeRumwell & McPharlin, (2009), Detroit Medical Center, (2012),

Zwiebel & Pellerito, (2005).

Preliminary ReportVascular Lab Report

Indication: Syncope

On the right:

Smooth dense plaque visualized in ICA,

PSV of ICA was 74 cm/sec ESV of 26cm/sec

B-mode images and velocities are consistent with 1-39% diameter reduction of the proximal internal carotid artery.

Right Brachial Systolic: 124 mmHg

Left Brachial Systolic: 120 mmHg

Vertebral arteries: appeared to have ante grade flow bilaterally

On the left:

Irregular dense plaque visualized in ICA,

PSV of ICA was 107cm/sec ESV of 27cm/sec

B-mode images and velocities are consistent with 1-39% diameter reduction of the proximal internal carotid artery.

Detroit Medical Center, (2012)

Preliminary Report Continued

On the left, there was a dissection in the mid common carotid

artery visualized.

The velocities pre dissection were 68 cm/sec, and the

velocities post dissection were 228 cm/sec.

There was a clip that was shadowing out a partial area of the

common carotid artery.

Doctor was notified of the results.

Detroit Medical Center, (2012)

Conclusion

• Patient: MJ, 80 year old female

• Symptom: Syncope

• History: Prior carotid aneurysm surgery

Detroit Medical Center, (2012)

Rumwell & McPharlin, (2009) Zwiebel and Pellerito, (2005)

Detroit Medical Center, (2012)

Conclusion• Waveform Interpretation:

Pre-dissection:• Laminar flow with spectral window intact• Moderate pulsatility• Normal PSV of 68 cm/sec

False Lumen:• Reversal of flow : below baseline

Post-dissection: • Turbulent flow with spectral window filled in• Moderate pulsatility• Suggested jet like PSV of 228 cm/sec

• Hemodynamics:• Area of flow separation post dissection (Bernoulli Principle)• Turbulent flow post dissection with mosaic patterns• Retrograde flow in false lumen Detroit Medical Center, (2012)

Zwiebel and Pellerito, (2005)Rumwell & McPharlin, (2009),

Conclusion

• B-Mode Images:

• Plaque visualized ICA Bilaterally

• Left Mid CCA Dissection and clip with shadow

• Suggested findings:

• Left Side Common Carotid Artery Dissection, Clip shadowing

area of dissection.

• 1- 39% stenosis Bilaterally in ICA

• Treatment: Anticoagulation

Detroit Medical Center, (2012)

References

References

Internet Scientific Publications, ISPUB.com (2012) , The Internet Journal of Neurosurgery

(Volume 7 No. 2), www.ISPUB.com

Rumwell, C. & McPharlin, M. (2009). Vascular technology: An illustrated review (4th ed.).

Pasadena, CA: Davies Publishing

Zwiebel, W. & Pellerito, J, (2005). Introduction to vascular ultrasonography (5th ed.).

Philadelphia, PA: Elsevier Saunders