Multimodality Imaging of Carotid Stenosis

Theodor Adla; Radka Adlova

doi:10.1055/s-0035-1556056

International Journal of Angiology, Table of Contents

Int J Angiol 2015; 24(03): 179-184
DOI: 10.1055/s-0035-1556056

Invited Paper

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Multimodality Imaging of Carotid Stenosis

Theodor Adla

¹Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

,

Radka Adlova

²Complex Cardiovascular Centre for Adult Patients, Cardiology Clinic of the 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic

› Author Affiliations

Abstract

Four diagnostic modalities are used to image the following internal carotid artery: digital subtraction angiography (DSA), duplex ultrasound (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). The aim of this article is to describe the potentials of these techniques and to discuss their advantages and disadvantages. Invasive DSA is still considered the gold standard and is an indivisible part of the carotid stenting procedure. DUS is an inexpensive but operator-dependent tool with limited visibility of the carotid artery course. Conversely, CTA and MRA allow assessment of the carotid artery from the aortic arch to intracranial parts. The disadvantages of CTA are radiation and iodine contrast medium administration. MRA is without radiation but contrast-enhanced MRA is more accurate than noncontrast MRA. The choice of methods depends on the clinical indications and the availability of methods in individual centers. However, the general approach to patient with suspected carotid artery stenosis is to first perform DUS and then other noninvasive methods such as CTA, MRA, or transcranial Doppler US.

Keywords

carotid artery stenosis - digital subtraction angiography - duplex ultrasound - computed tomography angiography - magnetic resonance angiography

Full Text

References

References
1 Collaborators NASCET ; North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991; 325 (7) 445-453
2 ECST Collaborative Group. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351 (9113) 1379-1387
3 Williams MA, Nicolaides AN. Predicting the normal dimensions of the internal and external carotid arteries from the diameter of the common carotid. Eur J Vasc Surg 1987; 1 (2) 91-96
4 Rothwell PM, Gibson RJ, Slattery J, Sellar RJ, Warlow CP. Equivalence of measurements of carotid stenosis. A comparison of three methods on 1001 angiograms. European Carotid Surgery Trialists' Collaborative Group. Stroke 1994; 25 (12) 2435-2439
5 Davies KN, Humphrey PR. Complications of cerebral angiography in patients with symptomatic carotid territory ischaemia screened by carotid ultrasound. J Neurol Neurosurg Psychiatry 1993; 56 (9) 967-972
6 Elgersma OE, Buijs PC, Wüst AF, van der Graaf Y, Eikelboom BC, Mali WP. Maximum internal carotid arterial stenosis: assessment with rotational angiography versus conventional intraarterial digital subtraction angiography. Radiology 1999; 213 (3) 777-783
7 Anzalone N, Scomazzoni F, Castellano R , et al. Carotid artery stenosis: intraindividual correlations of 3D time-of-flight MR angiography, contrast-enhanced MR angiography, conventional DSA, and rotational angiography for detection and grading. Radiology 2005; 236 (1) 204-213
8 Heran NS, Song JK, Namba K, Smith W, Niimi Y, Berenstein A. The utility of DynaCT in neuroendovascular procedures. AJNR Am J Neuroradiol 2006; 27 (2) 330-332
9 Tanabe J, Tanaka M, Kadooka K, Hadeishi H. Efficacy of high-resolution cone-beam CT in the evaluation of carotid atheromatous plaque. J Neurointerv Surg 2015; (e-pub ahead of print)
10 Polak JF, Shemanski L, O'Leary DH , et al. Hypoechoic plaque at US of the carotid artery: an independent risk factor for incident stroke in adults aged 65 years or older. Cardiovascular Health Study. Radiology 1998; 208 (3) 649-654
11 Stein JH, Korcarz CE, Hurst RT , et al; American Society of Echocardiography Carotid Intima-Media Thickness Task Force; Endorsed by the Society for Vascular Medicine. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. J Am Soc Echocardiogr 2008; 21 (2) 93-111 , quiz 189–190
12 Grant EG, Benson CB, Moneta GL , et al; Society of Radiologists in Ultrasound. Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis—Society of Radiologists in Ultrasound consensus conference. Ultrasound Q 2003; 19 (4) 190-198
13 Wardlaw JM, Chappell FM, Stevenson M , et al. Accurate, practical and cost-effective assessment of carotid stenosis in the UK. Health Technol Assess 2006; 10 (30) iii-iv , ix–x, 1–182
14 Sarkar S, Ghosh S, Ghosh SK, Collier A. Role of transcranial Doppler ultrasonography in stroke. Postgrad Med J 2007; 83 (985) 683-689
15 Shalhoub J, Owen DRJ, Gauthier T, Monaco C, Leen ELS, Davies AH. The use of contrast enhanced ultrasound in carotid arterial disease. Eur J Vasc Endovasc Surg 2010; 39 (4) 381-387
16 Sun K, Li K, Han R , et al. Evaluation of high-pitch dual-source CT angiography for evaluation of coronary and carotid-cerebrovascular arteries. Eur J Radiol 2015; 84 (3) 398-406
17 Bivard A, Spratt N, Levi C, Parsons M. Perfusion computer tomography: imaging and clinical validation in acute ischaemic stroke. Brain 2011; 134 (Pt 11) 3408-3416
18 Weber J, Veith P, Jung B , et al. MR angiography at 3 Tesla to assess proximal internal carotid artery stenoses: contrast-enhanced or 3D time-of-flight MR angiography?. Clin Neuroradiol 2015; 25 (1) 41-48
19 van Everdingen KJ, van der Grond J, Kappelle LJ, Ramos LM, Mali WP. Diffusion-weighted magnetic resonance imaging in acute stroke. Stroke 1998; 29 (9) 1783-1790
20 Chen F, Ni YC. Magnetic resonance diffusion-perfusion mismatch in acute ischemic stroke: An update. World J Radiol 2012; 4 (3) 63-74
21 Maeda M, Yuh WTC, Ueda T , et al. Severe occlusive carotid artery disease: hemodynamic assessment by MR perfusion imaging in symptomatic patients. AJNR Am J Neuroradiol 1999; 20 (1) 43-51
22 Trivedi RA, Green HA, U-King-Im J , et al. Cerebral haemodynamic disturbances in patients with moderate carotid artery stenosis. Eur J Vasc Endovasc Surg 2005; 29 (1) 52-57
23 Jaff MR, Goldmakher GV, Lev MH, Romero JM. Imaging of the carotid arteries: the role of duplex ultrasonography, magnetic resonance arteriography, and computerized tomographic arteriography. Vasc Med 2008; 13 (4) 281-292
24 Johnston DC, Goldstein LB. Clinical carotid endarterectomy decision making: noninvasive vascular imaging versus angiography. Neurology 2001; 56 (8) 1009-1015
25 Qureshi AI, Suri MF, Ali Z , et al. Role of conventional angiography in evaluation of patients with carotid artery stenosis demonstrated by Doppler ultrasound in general practice. Stroke 2001; 32 (10) 2287-2291
26 Brott TG, Halperin JL, Abbara S , et al; 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/ SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. Vasc Med 2011; 16 (1) 35-77