Author： Lee Hetherington Rebecca Smith Kristine Anne Spargo Amanda Louise Gibbs Harry Hugh
Publisher： Society for Vascular Ultrasound
ISSN： 1539-5898
Source： Journal of Vascular Technology, Vol.24, Iss.2, 2000-06, pp. : 101-104
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Abstract
Introduction: Spontaneous dissection of the internal carotid artery (ICA) is a rare but important cause of stroke in young patients. This study reviews our experience with duplex scanning for the diagnosis and follow-up of ICA dissection.Methods and Materials: A retrospective study of patients presenting with symptomatic ICA dissection was performed from 1992 to 1998. A cerebrovascular duplex scan (CDS), including B-mode and Doppler measurement of the peak systolic velocity (PSV) and end diastolic velocity (EDV), was recorded in the common carotid artery (CCA), the ICA, and the external carotid artery (ECA) at the time of presentation and the follow-up.Results: Seventeen ICA dissections were identified with ultrasound and confirmed by angiography, magnetic resonance imaging (MRI) computed tomography (CT),or autopsy. The mean age of the patients was 46 years (range, 23-57 years), with 9 males. Presenting symptoms included hemiparesis, dysphasia, headache, Horner's syndrome, and visual disturbance. B-mode scanning demonstrated an ICA intimal flap in 3 cases, with the remaining 14 vessels appearing normal. A high resistance, damped ICA Doppler waveform was present in all cases. The PSV recorded in the symptomatic ICA was significantly less than the contralateral side (19 cm/sec versus 75 cm/sec; p 0.05) and less than 28 cm/sec in all cases. EDV flow was absent in all but one case. The PSV and EDV recorded in the CCA were also significantly less than the asymptomatic side. Two patients died from stroke-related causes. The remaining 15 patients underwent surveillance CDS. Mean follow-up was at 8.5 months (range, 2 weeks to 28 months). Duplex assessment demonstrated two distinct patterns: Group 1 included those with an occlusion or remaining abnormal Doppler signal in the ICA (3/15); Group 2 had normalization of Doppler velocities recorded in the symptomatic carotid system (12/15). In Group 2 patients, there was no significant difference between Doppler velocities recorded in the ICA or CCA on the symptomatic side compared to the contralateral side. In one patient, these velocities had returned to normal after only 3 weeks.Conclusion: Symptomatic ICA dissection has a characteristic duplex pattern with a high resistance, damped waveform present in the ICA in all cases. These changes resolve completely in the majority of cases and normalization may occur as early as 2 weeks.
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