THREE-DIMENSIONAL ULTRASONOGRAPHY IN DIAGNOSING SUBTOTAL STENOSIS AND OCCLUSION OF INTERNAL CAROTID ARTERY
Keywords:
subtotal stenosis and occlusion of internal carotid artery, three-dimensional ultrasonography, three-dimensional CT angiography, carotid angiographyAbstract
Background. Ultrasonographic discrimination of subtotal stenosis from occlusion of the internal carotid artery (ACI) is frequently extremely complicated. Three-dimensional ultrasonography (3D US) is more reliable than color duplex ultrasonography. However, due to possible errors in the evaluation of subtotal stenosis and occlusion, 3D US should be complemented either by three-dimensional CT angiography (3D CTA) or classic angiography. Correct evaluation is extremely important for operative treatment of subtotal stenosis.
Methods. In 22 patients, 3D US revealed occlusion of the ACI and in 11 patients subtotal stenosis. In all cases, the ultrasonographic findings were compared with 3D CTA findings, in 8 cases also with those of conventional angiography.
Results. In two patients, 3D US evaluated the blockage as an occlusion while 3D CTA as well as angiography showed it to be a subtotal stenosis. In one patient, lumen reduction was so marked that it was not revealed by 3D CTA but only by angiography. In another case, the filiform ACI stenosis was covered by a distinct acoustic shadow of calcinated plaque. When compared, the remaining findings showed no significant differences.
Conclusions. It is our opinion that 3D US is a good screening diagnostic method for diagnosing subtotal stenosis and occlusion of the ACI. However, owing to possible errors, it should be combined with 3D CTA or classic angiography. A precise evaluation is very important as subtotal ACI stenosis requires early operative treatment while ACI occlusion only requires conservative treatment.
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References
Franceschi D, Bondi J, Rubin JR. A new approach for three-dimensional reconstruction of arterial ultrasonography. J Vasc Surg 1992; 15: 800–5.
Rosenfield K, Boffetti P, Kaufman J et al. Three-dimensional reconstruction of human carotid arteris from images obtained during noninvasive B-mode ultrasound examination. AMJ Cardiol 1992; 70: 379–84.
Rankin RN, Fenster A, Downey DB et al. Three-dimensional sonographic reconstruction: Techniques and diagnostic applications. AJR 1993; 161: 695–702.
Hamper VM, Trapanotto V, Slith S, Dejong MR, Caskey CI. Three-dimensional US preliminary clinical experience. Radiology 1994; 191: 397–401.
Delker A, Polz H. 3D ultrasound of carotid artery using a sensor as a space orientation. Cerebrovasc Dis 1996; 6: Suppl 3: 2–2.
Griewing B, Schminke V, Morgenstern C, Walker ML, Kessler C. Threedimensional ultrasound angiography (power mode) for the quantification of carotid artery atherosclerosis. J Neuroimaging 1997; 7: 40–5.
Steinke W, Meairs S, Ries S, Hennerici M. Sonographic assessment of carotid artery stenosis. Comparison of power Doppler imaging and color Doppler flow imaging. Stroke 1996; 27: 91–4.
Kaps M, Schaffer P, Seidl G, Droste DW. Transkranielle Doppler Sonographie mit Echokontrastmitteln. Focus MUL 1995; 12: 135–42.
Sameshima T, Futami S, Morita Y et al. Clinical usefulness of and problems with three-dimensional CT angiography for the evaluation of arteriosclerotic stenosis of the carotid artery: comparison with conventional angiography, MRA, and ultrasound angiography. Surg Neurol 1999; 51: 300–9.
Bermann SS, Devine JJ, Erdoes LS, Hunter GC. Distinguisching carotis artery pseudoocclusion with color flow Doppler. Stroke 1995; 26: 434–8.
Hetzel A, Eckeneweber B, Trummer B, Wernz M, Reutern GM. Farbkodierte Duplexsonographie bei präoklusiven Stenosen der Arteria carotis interna. Ultraschall in Med 1993; 14: 240–6.
Bendick PJ, Brown W, Hernandez D, Glower JL, Bove PG. Three-dimensional vascular imaging using Doppler ultrasound. Am J Surg 1998; 176: 183–7.
Huston J, Douglas A, Nickols P, Luetmer H, Rydberg CH et al. MR angiosonographic and sonographic indications for endarterectomy. Am J Neuroradiol 1998; 19: 309–15.
Bartels E, Flügel KA. Evaluation of extracranial vertebral artery dissection with Doppler color – flow imaging. Stroke 1996; 27: 290–5.
Sturzenegger M. Spontaneous internal carotid artery dissection: early diagnosis and management in 44 patients. J Neurol 1995; 242: 231–8.
Leclerc X, Godefrey O, Lucas C et al. Internal carotid arterial stenosis: CT angiography with volume rendering. Radiology 1999; 210: 673–82
Robertson JT. Carotid endarterectomy. In: Welch KMA, Caplan LR, Reis DJ, Siesjö BK, Weir B eds. Cerebrovascular diseases. San Diego: Academic Press, 1997: 582–6.
Giordano MJ, Tront HH, Kozloff L, De Palma RG. Timing of carotid artery endarterectomy after stroke. J Vasc Surg 1985; 2: 250–4.
Despot J. Kirurgija ekstrakranijske cerebrovaskularne bolesti. In: Demarin V et al. eds. Moždani krvotok – klinički pristup. Zagreb: Naprijed, 1994: 253–309.
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