Page 46 - Virtual Vascular Vol 3

Vascular Lab Video: Carotid Duplex

Carotid Endarterectomy

• Transient ischaemic attack is a focal neurological deficit which
recovers spontaneously within 24 hours, whereas a neurological

symptoms of a stroke last more than 24 hours

• Carotid endarterectomy is indicated if the patient is symptomatic

and has significant carotid stenosis

• Investigations include carotid duplex, with or without CT or MR

angiogram

• CT / MRI brain is important pre-operatively to document ischaemic
changes and to rule out space occupying lesions

• ECG, Holter tape, or ECHOcardiogram are important if there is a
query of cardiac arrhythmia or emboli

• Patient should take anti-platelet agents (aspirin or clopidogrel) pre-
and post-operatively.

DUPLEX carotid ULTRASOUND of a patient with a 80% carotid stenosis. B-mode
image showed the large plaque. Additionl doppler study revealed a flow-velocity spectrum • Caroid endarterectomy can be performed under general or reginal
characteric of a high grade stenosis. Interanl carotid artery (ICA) Peak systolic velocity (PSV)
is one of the primary parameters for determination of the degree of stenosis. A PSV of anaesthesia.

<125 cm/s refers to stenosis <50%. PSV>230 cm/s denotes a significant stenosis of >70%.
Additional secondary parameters used include End diastolic vecocity (EDV) and ICA/CCA
PSV ratio. A EDV of >100 cm/s also characterises >70% stenosis.

46 47