CAROTID PATHOLOGIES
Moyamoya disease:
 Is used to describe the appearance of multiple collateral vessels associated
with extensive stenosis of the intracranial carotid( usually distal ICA) and
vertebral arteries.
 One of the rarest forms of occlusive cerebrovascular disorders encountered in
neurosurgery is moyamoya disease. Fragile blood vessels proliferate around
ablocked artery in an attempt to bypass an occlusion. Their appearance on a
cerebral angiogram resembles a "puff of smoke" or "moyamoya," a term
coined by a Japanese team who first described the disease. It can affect
both children and
adults usually with symptoms of TIAs, strokes, headaches and seizures.
There is no effective drug treatment for moyamoya disease and surgery is
aimed at bypassing the blockage with another artery to restore normal blood
flow.
 Typical symptoms are:
1. Strokes (sustained weakness or numbness in an arm or leg, difficulty
speaking, visual abnormalities or problems walking)
2. Transient ischemic attacks, or TIAs (temporary stroke-like symptoms that
don't last long)
3. Headaches
4. Progressive cognitive or learning impairment
http://neurosurgery.stanford.edu/moyamoya/
Takayasu’s arteritis
• Stenosis or aneurysms of the Aorta, Arch branches and renal vessels.
Carotid body tumour
• A solid lesion is seen on ultrasound splaying the carotid bifurcation. The mass
is highly vascular.
Fibromuscular dysplasia
• The ICA and vertebral arteries are shown to be narrowed and dilated as a ‘string of
bead” appearance. The ICA is more commonly affected than the vertebral arteries.
• This can lead to dissection and is thought to be associated with an increase in
intracranial aneurysms.
Fibromuscular dysplasia for demonstration of disease only
(NOTE: From Module 3 Outline)
http://www.biomedsearch.com/
Power Doppler showing stenotic constrictions and aneurysmal dilations in FMD-affected renal
artery
http://www.pear.co.nz/asum/doc.php?d=5&t=-1&tab=6&imageID=58
Fibromuscular dysplasia of a renal artery causing arterial narrowing.
http://www.yoursurgery.com/ProcedureDetails.cfm?BR=3&Proc=70
Carotid body tumour
Carotid body tumor in the carotid bifurcation transverse
Carotid body tumor in the carotid bifurcation longitudinal
http://www.ultrasoundcases.info/Slide-View.aspx?cat=291&case=938
Carotid artery dissection
 Often demonstrated in B-mode as a thin linear echo running through the
length of the vessel. Carotid Aneurysm
 More commonly distal CCA and ICA dilatation often with mural thrombus.
http://www.riversideonline.com/health_reference/Questions-Answers/AN00977.cfm
http://uvahealth.com/services/vascular-center/treatment/arterial-dissections
http://www.painneck.com/blog/carotid-artery-dissection-neck-painhorner%E2%80%99s-syndrome/
http://www.angiologist.com/vascular-laboratory/carotid-duplex-protocol/
Carotid Aneurysm
 More commonly distal CCA and ICA dilatation often with mural thrombus.
 A bulging or ballooning in the wall of a blood vessel. Caused when a portion
of the artery wall weakens. Like a balloon, as the aneurysm expands, the
artery wall grows progressively thinner, increasing the likelihood that the
aneurysm will burst.
http://ult.sagepub.com/content/18/1/18/F3.expansion
Vertebral Artery Disease
 Occlusion may be diagnosed only if a clear image of the vessel is obtained.
 There are no established criteria for vertebral artery stenosis.
 Reverse or retrograde flow of the vertebral artery leads to an examination of
the subclavian, innominate (BCA) and brachial arteries.
 Atherosclerosis is the dominant nontraumatic condition seen in the vertebral
artery. The most frequent site of involvement is the vertebral artery origin
from the subclavian artery.
 Color Doppler sonography is the most appropriate method for diagnosis of
carotid artery stenosis, but it is not as appropriate for vertebral artery
stenosis. It is difficult to show the proximal vertebral artery because of its
many anatomic characteristics, such as a small diameter, a deep location,
tortuosity, and a perpendicular origin from the subclavian artery.
Normal vertebral artery
Reversed flow in right vertebral artery
http://www.ultrasound-images.com/vascular.htm
Subclavian and Innominate (BCA) Artery Disease
 Ultrasound can be used to assess flow direction
 Again there are no established criteria for stenosis. A comparison with the
opposite subclavian artery or an increase in velocity over 200cm/s with post
stenotic waveform changes may indicate a significant stenosis.
 Alteration of the vertebral artery waveforms are shown, reversal, partial
reversal absence of flow.