Imaging

Carotid Stenosis

Preliminary Diagnosis: Carotid Stenosis

I. What imaging technique is first-line for this diagnosis?

  • Ultrasound with Doppler interrogation and spectral waveform imaging

II. Describe the advantages and disadvantages of this technique for diagnosis of carotid stenosis.

Advantages

  • Relatively inexpensive

  • Does not use ionizing radiation

  • Can compare both left and right carotid vasculature

  • Useful for detecting low velocity flow at and distal to preocclusive stenoses

  • Useful for estimating degree of stenosis with velocity parameters

Disadvantages

  • May be difficult to examine vasculature in obese patients

III. What are the contraindications for the first-line imaging technique?

No significant contraindications

IV. What alternative imaging techniques are available?

  • MRA

  • Digital subtraction angiography (DSA)

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of carotid stenosis.

MRA

Advantages

  • Does not expose the patient to ionizing radiation

Disadvantages

  • Expensive

  • Requires significant patient cooperation to minimize motion artifact

  • May over or underestimate the degre of carotid stenosis due to flow turbulence

DSA

Advantages

  • It is the gold standard for documentation of carotid stenosis/occlusion.

Disadavantages

  • Expensive

  • Exposure to ionizing radiation

  • Invasive

  • May underestimate the degree of stenosis

VI. What are the contraindications for the alternative imaging techniques?

MRA

Absolute contraindication is non-MR-compatible hadware.

DSA

Relative contraindication is exposure to ionizing radiation in pregnant patients.

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