An Actual Case from :
Detroit Medical Center, Harper University Hospital Vascular
Lab
Presented By : Angela Bowling
Baker College Of Auburn Hills
Vascular Ultrasound
Winter, 2013

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Carotid Dissection:
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Description
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Typical Symptoms
•
Treatment
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Statistics
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Patient Information:
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Demographics
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Symptoms
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History
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Test Ordered
Images:
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Waveform Interpretation
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Hemodynamics
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B-Mode
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Preliminary Report
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Conclusion

• “Hemorrhage within the carotid wall”
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Trauma or Spontaneous
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Intima tears
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Dissecting the carotid artery into two parts
• “True Lumen”
• Usually crowded by false lumen
• “False Lumen”
• Can be patent or thrombosed
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Waveforms typically to/fro flow in false lumen.
Rumwell & McPharlin, (2009),
Zwiebel & Pellerito, (2005).
www.ispub.com, (2012

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Typical Symptoms:
•
Horner syndrome, (drooping eyelid, decreased pupil size)
• “Neck pain, headache, tinnitus, transient monocular blindness”
• Asymptomatic
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Treatment:
• Anticoagulation
• Surgical Stent
Zwiebel & Pellerito, (2005)
Rumwell & McPharlin, (2009)

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

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Initials: MJ
• Sex: Female
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Age: 80 years old
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Symptoms: Syncope
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History:
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Prior Carotid Aneurysm with Corrective Surgery
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Recent Fall down 2 steps due to syncope
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Test Ordered: Bilateral Carotid Study
Detroit Medical Center, (2012)
.

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

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

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

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

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

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

Detroit Medical Center, (2012)
Vascular 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)
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.

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Patient: MJ, 80 year old female
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Symptom: Syncope
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History : Prior carotid aneurysm surgery
Detroit Medical Center, (2012)
Detroit Medical Center, (2012 )
Rumwell & McPharlin, (2009)
Zwiebel and Pellerito, (2005)

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Waveform Interpretation:
Pre-dissection:
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Laminar flow with spectral window intact
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Moderate pulsatility
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Normal PSV of 68 cm/sec
False Lumen:
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Reversal of flow : below baseline
Post-dissection:
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Turbulent flow with spectral window filled in
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Moderate pulsatility
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Suggested jet like PSV of 228 cm/sec
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Hemodynamics :
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Area of flow separation post dissection (Bernoulli Principle)
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Turbulent flow post dissection with mosaic patterns
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Retrograde flow in false lumen
Detroit Medical Center, (2012)
Zwiebel and Pellerito, (2005)
Rumwell & McPharlin, (2009),

Detroit Medical Center, (2012)
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B-Mode Images :
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Plaque visualized ICA Bilaterally
• Left Mid CCA Dissection and clip with shadow
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Suggested findings :
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Left Side Common Carotid Artery Dissection, Clip shadowing area of dissection.
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1- 39% stenosis Bilaterally in ICA
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Treatment : Anticoagulation

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 (4 th ed.).
Pasadena, CA: Davies Publishing
Zwiebel, W. & Pellerito, J, (2005). Introduction to vascular ultrasonography (5 th ed.).
Philadelphia, PA: Elsevier Saunders