Carotid Artery Disease Part 2
A Trainee Guide to Plaque Types and Stenosis Grading
Hypoechoic
Echogenic
Saw 2007, figure 11
http://article.wn.com/view/2012/06/10/Eye_Test_Could_Detect_Carotid_
Artery_Stenosis_Stroke_Risk_Fa/
Commonly known as a “Fatty Streak” (Ahuja 14:6)
Carries an increased risk of embolisation (ahuja
14:6)
Description here
Mixed
Calcified
Saw 2007 figure 13
Vascular medicine lab.com 2013
Focal or diffuse areas of hypoechogenicity within
the plaque formation (Ahjua 14:6)
Echogenic focus along the vessel wall with
posterior acoustic shadowing (Hennginson
496)(ahuja 14:6)
May be focal or diffuse (Ahuja 14:6)
Carries a decreased risk of embolisation (Ahuja
14:6)
If on the superficial wall may make interrogation
with Colour Doppler difficult
Sonolucent areas may be indicative of intraplaque
haemorrhage (Henningson 495)
Carries an increased risk of embolisation
Intermediate
http://e-ultrasonography.org/journal/view.php?number=19
Description here
Stenosis Grading
0
<15 % Diameter Reduction
Normal waveform and Image
Laminar Flow
50-69% Diameter Reduction
http://www.eurorad.org/eurorad/view_figure.php?pubid=5367&figid=
12037&nr=1 figure 1
Pansystolic Spectral Broadening
PSV >125 cm/sec and EDV < 110 cm/sec
ICA/CCA >2
Mild disturbance in intraluminar colour hues at
the site of and distal to stenosis (Ahuja 14:6)
reference
Deceleration Spectral Broadening
PSV <125 cm/sec (ASUM)
EDV <40cm/sec (Ahuja 14:7)
Uniform intraluminal colour flow
70-79% Diameter Reduction
reference
Pansystolic Spectral Broadening
PSV >270 cm/sec or EDV > 110 cm/sec
ICA/CCA >4
Aliasing seen at the stenosis with post stenotic
turbulence (Ahuja 14:7)
16-49% Diameter Reduction
reference
Pansystolic Spectral Broadening
PSV <125 cm/sec
EDV <40cm/sec (Ahuja 4:7)
Uniform intraluminal colour flow
80-90% Diameter Reduction
reference
Pansystolic Spectral Broadening
PSV >270 cm/sec or EDV > 140 cm/sec
ICA/CCA >4
Aliasing seen at the stenosis with post stenotic
turbulence (Ahuja 14:7)
Occluded
reference
No colour flow seen (Henningson 497, Asum)
Terminal thump in systole (henningosn 497, asum)
PSV and EDV absent
Echogenic material will completely fill the vessel
lumen (Hennginson 497) (ahuja 14:6)
Ipsilateral ECA may demostrate internal flow
pattern (Henningson 497)
Reduction in overall size with chronic occlusion