Related Experiment Videos
Carotid stump syndrome: a colour-coded Doppler flow study
D S Quill1, M P Colgan, D S Sumner
1Department of Peripheral Vascular Surgery, School of Medicine, Southern Illinois University, Springfield 62794-9230.
Insights
Large internal carotid stumps and external carotid stenosis increase stroke risk in patients with internal carotid artery occlusion. Angiodynography can identify these high-risk patients for potential treatment.
Area of Science:
- Vascular Surgery
- Neurology
- Medical Imaging
Background:
- Internal carotid artery (ICA) occlusion can lead to cerebral ischemia.
- The role of the carotid bifurcation, including residual stumps and external carotid artery (ECA) stenosis, in causing ischemic events is debated.
Purpose of the Study:
- To investigate the association between specific findings at the carotid bifurcation and the development of cerebral ischemic symptoms in patients with ICA occlusion.
- To evaluate the utility of color-coded Doppler flow imaging (angiodynography) in assessing these risks.
Main Methods:
- Angiodynography was performed on 29 patients with 30 ICA occlusions.
- Analysis focused on the morphology of internal carotid stumps and the presence of external carotid stenosis.
- Patients were followed for an average of 18 months for symptoms of cerebral ischemia.
Main Results:
- Large internal carotid stumps, appearing as intravascular cul-de-sacs with reversed flow vortices, were observed.
- Nine patients (9 arteries) had large carotid stumps or significant ECA stenosis.
- These patients were significantly more likely to experience cerebral ischemic symptoms (P = 0.016).
Conclusions:
- Embolization from the carotid bifurcation (residual stump or ECA stenosis) is a likely cause of episodic cerebral ischemia after ICA occlusion.
- Angiodynography is a potentially valuable tool for identifying patients at higher risk who may benefit from intervention.
Abstract:
Colour-coded Doppler flow imaging (angiodynography) was performed on 29 patients with 30 internal carotid artery occlusions. Large internal carotid stumps were revealed as intravascular cul-de-sacs demonstrating vortices of blue flow reversal. Large carotid stumps or significant external carotid stenoses were present in nine patients (9 arteries). Such patients were significantly more likely to develop symptoms of cerebral ischaemia during follow up which averaged 18 months (P = 0.016; Fisher exact). These results support the concept of embolisation from the carotid bifurcation (residual stump or external stenosis) as a cause of episodic cerebral ischaemia following internal carotid occlusion. Angiodynography may prove to be a useful tool for selecting appropriate patients for treatment.