Doppler Ultrasound Scanning of the Carotid Bifurcation

Carotid bifurcation atherosclerosis was demonstrated in 34 of 108 patients with familial hypercholesterolemia and coronary artery disease by B-scan, continuous-wave Doppler sonography, and intravenous digital subtraction anglography. An intensive combined therapy of diet, colestipol, and nicotinic acid was mounted to control the hypercholesterolemia of these patients. Their serial sonographies and digital subtraction anglography were evaluated independently by technical specialists who served as coinvestigators. The data obtained suggest that 1) extracranial arterial disease can develop concurrently with coronary artery disease in a significant proportion of patients with familial hypercholesterolemia, and 2) amaurosis fugax, transient ischemic attack, cerebral infarction, and myocardial infarction did not recur during 58-72 months of control of familial hypercholesterolemia in this series of patients. Increased susceptibility to premature coronary artery disease (CAD) has been well documented. 23 There is scant information about the prevalence of extracranial carotid arterial disease in patients with familial hypercholesterolemia, particularly in those patients with known CAD. Because ultrasonography and intravenous digital subtraction angiography (IV-DSA) 4 "* have created a safe and reliable means to evaluate extracranial arterial lesions, we used these techniques to determine the possible effect of lowering cholesterol and lipid on the carotid bifurcation pathology in patients with familial hypercholesterolemia. Our goal was to determine whether long-term control of hypercholesterolemia would reduce the excess risk for stroke in a series of familial hypercholesterolemic patients with extracranial carotid arterial disease and premature CAD. Received May 15, 1985; accepted February 6, 1987. Subjects and Methods Patient PopulationOne hundred eight unselected patients with familial hypercholesterolemia and CAD (angina and/or postmyocardial infarction), aged 39-62, were evaluated. Diagnosis of heterozygous familial hypercholesterolemia was established by the demonstration of persistent hypercholesterolemia (serum total cholesterol s 300 mg/dl, LDL cholesterol ^1 9 0 mg/dl, and triglyceridê 200 mg/dl); elevated LDL cholesterol that responded minimally to a diet low in cholesterol and saturated fat; demonstration of a similar plasma lipid-lipoprotein abnormality with or without clinical CAD in firstdegree family members; and characteristic clinical manifestations of familial hypercholesterolemia including tendinous xanthomas with or without corneal arcus.3 After obtaining informed consent, 34 patients in whom extracranial carotid arterial atherosclerosis had been demonstrated were enrolled in a diet-drug treatment program for long-term management of hypercholesterolemia. Women of childbearing age and patients with secondary hypercholesterolemia or who were receiving drugs or hormones known to exert significant effects on lipid metabolism were excluded from the study. Laboratory DeterminationsDiagnosis of CAD was es...

Section: Discussionsupporting

confidence: 58%

Extracranial carotid arterial disease in patients with familial hypercholesterolemia and coronary artery disease treated with colestipol and nicotinic acid.

Kuo¹,

Toole²,

Schaaf³

et al. 1987

“…Comparison of our data with those reported by Spencer et al 10 produced very similar results, while there is some discrepancy with results from Blackwell et al 12 We reported a positive angiogram as showing a stenosis of 50% or greater, as did Spencer, but this was not specified by Blackwell. If the latter considered a lesser stenosis as being positive, this may account for the variance.…”

Section: Discussionsupporting

confidence: 67%

Cerebrovascular evaluation: assessment of Doppler scanning of carotid arteries, ophthalmic Doppler flow and cervical bruits.

Shoumaker¹,

Bloch²

1978

SUMMARY In 38 patients who underwent cerebrovascular evaluation followed by angiography the Doppler ultrasound scanning technique was found to be an excellent screening procedure for detecting marked stenosis (>50%) or occlusion of the internal carotid artery (93% correlation). It is noninvasive, easily reproducible and can be performed by a qualified technician. The major problems are: the inability to detect ulcerated plaques without marked stenosis, the requirement for patient cooperation (lying still for periods of 15 minutes), and the fact that it assesses only the extracranial circulation.Screening with just the directional ophthalmic Doppler flow signal yielded a high percentage of false negatives (13%). The presence of a cervical bruit may indicate an underlying stenosis of the internal carotid artery, but may also be due to stenosis of the external carotid artery or other factors such as increased blood flow, vessel tortuosity, etc. (12% false positives). Absence of a cervical bruit does not exclude internal carotid artery disease (ulcerated nonstenotic plaque or occlusion).

“…All CWD scans were performed on supine patients with the 1050 DOPSCAN* imaging system and a 5 MHz transducer using the techniques described by Spencer et al' and Blackwell et al 2 CWD was interpreted as abnormal whenever there was no flow detectable (obstruction) or there was a doppier frequency shift greater than 6 KHz (> 50% stenosis). RTU studies were performed with an 8 MHz high-resolution Biosonics scannert with patients seated in a dental chair.…”

Section: Methodsmentioning

confidence: 99%

Asymptomatic bruit, carotid and vertebrobasilar transient ischemic attacks--a clinical and ultrasonic correlation.

Lo¹,

Ford²,

McKinney³

et al. 1986

SUMMARY One hundred patients with asymptomatic carotid bruit or transient ischemic attack (TIA) underwent continuous-wave Doppier (CWD) and real time ultrasound (RTU) testing of their cervical carotid arteries. After ultrasonic studies, 51 patients also underwent bilateral carotid angiography. There was 95 % agreement between CWD and angiography for the diagnosis of a significant (> 50 %) stenosis. The RTU diagnosis of a normal or occluded vessel was correct in 100% of cases. Seven plaques appreciated on RTU may not have been large enough for detection by angiography. In this small series, ulceration confirmed pathologically was more reliably predicted by RTU than by cerebral angiography.Significant ipsilateral carotid plaques occurred more often in patients with amaurosis fugax than in patients with hemispheric TIAs. Ipsilateral plaque ulceration occurred in 50% of symptomatic carotid bruits, but in only 10% of asymptomatic carotid bruits. Plasma concentrations of total cholesterol were significantly higher in TIA patients with carotid stenosis than in controls. Stroke Vol 17, No 1, 1986 CEREBRAL ANGIOGRAPHY is a reliable technique for diagnosis of cerebrovascular disease, but its usage is limited by its high cost and associated risks. Carotid ultrasound testing is safer and less expensive. We used the combination of continuous-wave Doppier (CWD) and real time ultrasound (RTU) testing to evaluate the carotid bifurcations of 100 patients with asymptomatic carotid bruit (ACB) and transient ischemic attack. Material and MethodsFrom June 1982 to September 1983, 100 consecutive Caucasian patients referred to the Neurosonology laboratory with either ACB or TIA were examined by CWD and RTU. These patients ranged in age from 40 to 84 years (table 1). Of 100 patients, 15 had asymptomatic carotid bruit (ACB), 19 had amaurosis fugax, 28 had vertebrobasilar TIAs and 38 had hemispheric TIAs. Fifty-one also underwent fourvessel cerebral angiography and 19 underwent carotid endarterectomy.All CWD scans were performed on supine patients with the 1050 DOPSCAN* imaging system and a 5 MHz transducer using the techniques described by Spencer et al' and Blackwell et al.2 CWD was interpreted as abnormal whenever there was no flow detectable (obstruction) or there was a doppier frequency shift greater than 6 KHz (> 50% stenosis). RTU studies were performed with an 8 MHz high-resolution Biosonics scannert with patients seated in a dental chair. Longitudinal and transverse images of the carotid bifurcation were obtained and videotaped from anteroposterior, lateral and posterolateral projections.• RTU was interpreted as showing obstruction whenever there was no discernible lumen and no appreciable pulsation. Ulcerated plaque was diagnosed by RTU whenever the atheroma had an undercut, crater-like, or markedly irregular surface.The findings of CWD and RTU were compared with the results of cerebral angiography in the 51 patients who underwent angiography. For the correlation of ultrasound results with clinical data, CWD and RTU results ...