For each plaque feature, we will summarize the existing literature, associating each feature with stroke risk. In this review, we will describe technical considerations when performing CTA and then provide detailed descriptions of individual plaque characteristics that can be evaluated on CTA. While identifying thrombosis and the degree of stenosis on CTA is necessary in selecting patients for intervention, other plaque features evident on CTA are also valuable in determining the risk of stroke or TIA and in aiding management decisions. In addition to providing accurate information regarding the degree of luminal stenosis, CTA examinations can also provide rich detail regarding plaque morphology and features, given their superb spatial resolution. Although CTA does not have the same prospective evidence as MR imaging and ultrasound for predicting future cerebrovascular disease, CTA does provide valuable information regarding plaque characteristics that should not be ignored.ĬTA of the head and neck is a commonly acquired examination to evaluate vessel patency in the setting of cerebrovascular ischemia, especially in the work-up of acute ischemic infarction. 3 ⇓- 5 CTA is often overlooked as a method for providing detailed evaluation of plaque characteristics, and it has certain benefits in terms of accessibility and ease of use in clinical workflow not present with multisequence MR imaging characterization of carotid plaque. 1, 2 In addition to MR imaging, contrast-enhanced sonography is also a powerful tool for evaluating carotid plaque vulnerability. Much of the literature of vessel wall imaging has centered on MR imaging because of its impressive contrast resolution and high sensitivity for identifying high-risk plaque features. Despite decades of using a degree of luminal stenosis as the primary determinant of treatment for patients with carotid artery stenosis, there has been a recent trend toward adopting advanced imaging techniques to provide a more complete plaque evaluation for more accurate risk assessment. Recent advances in vessel wall imaging have spurred a paradigm shift in the evaluation of carotid plaque. This narrowing may be detected by your doctor as a carotid bruit – a ‘whooshing’ noise due to turbulent flow, heard with a stethoscope placed on the side of the neck, over the carotid artery.ABBREVIATIONS: IPH intraplaque hemorrhage LRNC lipid-rich necrotic core The carotid arteries in the neck are a common source of small clots, especially if there is a narrowing of the blood vessel due to atherosclerosis, known as a carotid artery stenosis. Otherwise, there may be varying degrees of residual symptoms, with variable rates of recovery, right up to a completed infarction – a ‘full-blown’ stroke. If the clot is dissolved by the body’s natural processes within a few minutes, blood flow returns to the affected area of the brain, and function returns to normal. This is known as a posterior-circulation TIA. A clot in any blood vessel supplying the posterior part of the brain, the cerebellum, may cause unsteadiness, clumsiness, slurred speech or even loss of consciuosness. This may result in a range of sensory symptoms, such as numbness, tingling, or altered sensation, or motor symptoms – weakness of the face, arm or leg, commonly on one side of the body. Why would you need a carotid doppler ultrasound?Ī carotid doppler ultrasound is usually performed to assess the risk of stroke in a patient with episodes suggestive of cerebro-vascular disease, such as a transient ischaemic attack (TIA) – also known as a mini-stroke.Ī TIA is caused by a small clot temporarily blocking off an area of blood supply in the brain. Mild to moderate pressure may be necessary to obtain detailed images of the carotid arteries. The test consists of applying a small probe to the side of the neck, near the Adam’s apple, using sonographic gel applied to the skin.
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