CAROTID

DOPPLER SONOGRAPHY
Accurate, noninvasive
es=mate of the degree of
stenosis of the extracranial
internal caro=d arteries

Caro=d Duplex
B-mode ultrasonography
graphic image of the arterial
wall and can detect plaques
Pulsed doppler
ultrasonography analyzes
velocity and turbulence
related to stenosis

Caro=d Duplex

Caro=d Duplex
If caro=d Doppler scans
suggest occlusion,
conrma=on with
angiography is required!
High grade stenosis cannot
be ruled out in all cases.


A Compara=ve Study of Caro=d Duplex Scan, Magne=c Resonance
Digital Substrac=on Angiography and Caro=d Angiography in

Diagnosis of Clinically Signicant Caro=d Artery Stenosis

Caro=d Duplex
Posi=oning of the
transducer over the
posterior neck can also
dieren=ate normal, high
resistance, and absent ow
in the proximal vertebral
arteries.

TRANSCRANIAL DOPPLER
Measures the velocity of blood
ow in
Intracranial proximal cerebral
arteries (ICA)
Middle cerebral artery (MCA)
Anterior cerebral artery (ACA)
Posterior cerebral artery (PCA)
Ophthalmic artery
Basilar artery
Vertebral artery

TCD Insona=on

TCD probe is placed over

dierent acous=c
windows
Main parameters:
1) Blood ow velocity
2) Pulsa=lity

TCD Waveform
Ultrasonic beam of 2 MHz
frequency is produced from
piezoelectric crystals that have
been s=mulated electrically.
This beam bounces o the
erythrocytes within the
insonated artery. The reected
signal is received by the
transducer and converted to
an electric signal.

Transcranial Doppler (TCD)

1) Diagnosing intracranial stenosis or occlusion
2) Evalua=ng the hemodynamic signicance of
caro=d stenosis or occlusion
3) Assessing vasospasm in pa=ents with SAH
4) Screening for AVM
5) Iden=fying severely increased ICP
6) Diagnosing brain death
7) Detec=ng cerebral emboli
8) Sickle Cell Disease

CEREBRAL X-RAY ANGIOGRAPHY

Provides high-resolu=on images of the extracranial and

intracranial cerebral vasculature
Performed by threading a small catheter into the
cerebral vessels via the femoral artery

ANGIOGRAPHY

ANGIOGRAPHY
1)
2)
3)
4)
5)
6)

Occluded or steno=c vessels

Arterial dissec=ons
Aneurysms
Arteriovenous malforma=ons
Vasculi=c narrowing (beading)
Dural venous sinus thrombosis

CEREBRAL ANGIOGRAPHY
AV MALFORMATION

ANEURYSM

ANEURYSM

ANEURYSM

ANGIOGRAPHY: Complications
Stroke is the most important (in 1 to 2% of
pa=ents):
which results from emboli generated by the
catheter and which occurs most frequently
in older pa=ents with atherosclero=c
disease

CT ANGIOGRAPHY
Beams of x-rays are passed from a rota=ng
device through the area of interest in the
pa=ent's body from several dierent angles to
create cross-sec=onal images, which then are
assembled by computer into a 3D picture
The scan is performed simultaneously with a
high speed contrast media injec=on using a
technique called Bolus Tracking

CT ANGIOGRAPHY
Iden=fy aneurysms and
dissec=ons in the aorta
or in other blood
vessels
Detect atherosclero=c
disease
Examine the pulmonary
arteries in the lungs to
rule out pulmonary
embolism

CT ANGIOGRAPHY

CT ANGIOGRAPHY