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High-resistance Doppler flow pattern in extracranial carotid dissection
M Hennerici1, W Steinke, W Rautenberg
1Department of Neurology, University of Düsseldorf, West Germany.
Insights
Ultrasound can identify internal carotid artery dissection by detecting specific Doppler signals, aiding diagnosis even in atypical cases. This noninvasive method also helps monitor stenosis resolution over time.
Area of Science:
- Neurology
- Vascular Imaging
Background:
- Internal carotid artery dissection is a significant cause of cerebrovascular events.
- Conventional diagnosis relies on clinical symptoms and arteriography.
- Ultrasound offers a potential noninvasive diagnostic tool.
Purpose of the Study:
- To evaluate the utility of ultrasound in diagnosing internal carotid artery dissection.
- To identify characteristic hemodynamic features indicative of dissection.
- To assess ultrasound's role in monitoring disease progression and resolution.
Main Methods:
- Retrospective analysis of 22 patients with internal carotid artery dissection.
- Utilized Doppler ultrasound to detect hemodynamic features.
- Correlated ultrasound findings with arteriographic results and clinical presentation.
Main Results:
- Characteristic ultrasound findings suggested dissection in 76% (16/22) of patients.
- An intense, low-frequency Doppler signal with alternating flow direction was a key indicator.
- Ultrasound successfully monitored stenosis resolution in 64% (14/22) of patients, with changes noted between 2 days and 30 weeks.
Conclusions:
- Doppler ultrasound can noninvasively suggest internal carotid artery dissection through specific hemodynamic patterns.
- Ultrasound is valuable for monitoring the resolution of stenosis following dissection.
- This imaging modality can aid in the diagnosis of atypical cases and track recovery.
Abstract:
Internal carotid artery dissection is an increasingly recognized cause of cerebrovascular events. The diagnosis is conventionally established on the basis of characteristic clinical symptoms and arteriographic findings. However, the presence of characteristic hemodynamic features detected by ultrasound may already suggest the diagnosis, even in atypical cases. This is demonstrated in 16 (76%) of 22 patients with internal carotid artery dissection. An intense systolic low-frequency Doppler signal of alternating flow direction accessible in the neck, either along the extent of a luminal tapering stenosis or proximal to a severe obstruction at the skullbase, indicated this diagnosis. Resolution or decreasing stenosis may similarly be diagnosed noninvasively, as shown by results from subsequent arteriograms in 14 patients (64%). This occurred suddenly during sequential follow-up between 2 days and 30 weeks (mean, 6 weeks) after the diagnosis was made.