Cerebrovascular Evaluations

A Cerebrovascular Evaluation includes extensive evaluation of the cerebrovascular circulation from the subclavian artery to the intracranial cerebral arteries. The comprehensive nature of this study enables Pacific Vascular to maintain very high accuracy.

Clinical Indications:

  • Stroke
  • Symptoms of TIA: Unilateral weakness, numbness, tingling, speech difficulties, Stroke with recovery
  • Amaurosis Fugax or other visual disturbances
  • Symptoms of Vertebrobasilar Insufficiency: Dizziness, Imbalance, Loss of Consciousness, Confusion, Headache
  • Asymptomatic bruit
  • Pre-op high risk
  • Follow-up known ICA stenosis
  • Pulsatile neck masses 
Cerebrovascular Evaluations cerebrovascular Cerebrovascular Evaluations Cerebrovascular Evaluations

Duplex/color ultrasound is utilized to detect and quantify obstructions of the carotid, vertebral, and subclavian arteries. Internal carotid artery stenosis is reported in terms of diameter reduction as a percent stenosis. The vertebral and subclavian arteries are evaluated for obstructions and subclavian steal phenomenon. Evaluation for plaque ulceration and hemorrhage (where image quality permits), intimal dissection/flaps, aneurysm, carotid body tumor, fibromuscular dysplasia, kinking, and re-stenosis following carotid endarterectomy is also performed whenever possible.

Transcranial Doppler (TCD) is utilized to evaluate the major basal cerebral arteries for intracranial stenosis and occlusions, assess collateral flow patterns, identify arteriovenous malformations, cerebral emboli, mechanical compression of the vertebral arteries, and cerebral vasospasm in patients with subarachnoid hemorrhage.

CBEvaluations2 cerebrovascular Cerebrovascular Evaluations CBEvaluations2CBEvaluations3 cerebrovascular Cerebrovascular Evaluations CBEvaluations3

 

Pacific Vascular offers 4 different Cerebrovascular Evaluations:

Complete – Carotid/Verterbral/Subclavian Duplex + Transcranial Doppler (TCD)

Includes color duplex ultrasound evaluation of the bilateral carotid, vertebral and subclavian arteries and Transcranial Doppler (TCD).

Conditional – Carptod/Vertebral/Subclavian Duplex + TCD prn

Includes color duplex ultrasound evaluation of the bilateral carotid, vertebral and subclavian arteries and TCD, only if indicated*. TCD is helpful to determine the hemodynamic significance of a stenosis or detect intracranial stenosis and AV malformations.

*Indications for TCD:

  • >50% pre-cerebral artery stenosis (internal carotid, vertebral, proximal subclavian or innominate arteries)
  • Patient presents with stroke/TIA symptoms

Abbreviated – Carotid/Vertebral/Subclavian Duplex Only

Only includes bilateral carotid, vertebral, subclavian artery duplex, without TCD. This is frequently ordered for follow-up exams with a known carotid lesion(s).

Transcranial Doppler Only (TCD)

Clinical indications for TCD include the following:

  • Assessment for intracranial lesions in patients with TIA or stroke (carotid or vertebrobasilar territory)
  • Assessment of collateral pathways in patients with identified significant extracranial arterial occlusive disease
  • Assessment and follow-up of patients with cerebral vasospasm especially following subarachnoid hemorrhage
  • Assessment and follow-up of patients with intracranial arteriovenous malformation
  • Assessment for cerebral circulatory arrest (brain death)

 

TCD Emboli Monitoring Study

Stroke is largely thought to be the result of thromboembolic phenomenon most commonly attributable to atherosclerotic plaque at the carotid bifurcation.  Other sources of emboli, however, include the heart and other levels of the cerebral circulation outside of the carotid bifurcation.   Patients referred for cerebral emboli detection will typically present with symptoms of TIA or stroke (carotid or vertebrobasilar) to rule out emboli and, if present, identify their source.

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Right to Left Bubble Study (PFO)

Approximately 30% of the general population has potential for a cardiac right to left shunt (RLS), in most cases via a patent foramen ovale (PFO).  Additionally, approximately 11% have extracardiac shunts, primarily involving the pulmonary circulation. RLS’s provide a mechanism for paradoxical embolization of thrombotic material from the heart, pelvic veins or the deep veins of the lower extremities to the cerebral circulation which can result in ischemic stroke.

Clinical Indications:

  • Stroke/TIA patients in whom other underlying etiologies have been ruled out (usually a younger individual)
  • Patients with embolic pattern of infarction on cerebral imaging studies without identified embolic source

Prior arrangements with the hospital will need to have been made for nursing staff to be available to establish venous access (preferably in an antecubital vein), and mix, agitate, and inject the saline/air solution.

 

Temporal Arteritis Duplex

Sonographic appearance of inflammation or “halo” effect can be useful in the diagnosis of Temporal Arteritis.

A: Normal Temporal Artery B: Normal Temporal Artery C: Temporal Arteritis with "Halo" Effect D: Temporal Arteritis with "Halo" Effect cerebrovascular Cerebrovascular Evaluations Temporal Arteritis Duplex Image 300x221

A: Normal Temporal Artery
B: Normal Temporal Artery
C: Temporal Arteritis with “Halo” Effect
D: Temporal Arteritis with “Halo” Effect

 

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