Doppler ultrasound is a precise method for assessing stenosis and flow disturbances in the arteries supplying blood to the brain. Doppler examination of the cerebral arteries is performed in patients with risk factors for ischemic stroke, in people who have had a stroke, and in people who suffer from dizziness or frequent fainting. The ultrasound result is also helpful in planning and assessing the effects of endarterectomy, i.e. removal of atherosclerotic plaque from the affected vessel. Ultrasound examination of the carotid and vertebral arteries is painless and non-invasive, therefore it can be repeated as often as desired.
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Indications for Doppler ultrasound of the cerebral arteries
previous ischemic stroke,
past transient ischemic attack (TIA),
frequent headaches and dizziness, fainting,
atherosclerosis,
arterial hypertension,
diabetes,
abnormal blood lipid profile (e.g. disturbed HDL / LDL cholesterol ratio)
control of the arteries after the removal of atherosclerotic plaques (endarterectomy) or after the procedure of inserting the stent into the artery,
post-traumatic conditions of the neck area.
What does ultrasound of the carotid arteries look like?
Ultrasound examination of the cerebral arteries does not require any special preparation. During the examination, the patient is lying down. It is necessary to slightly tilt and twist the head to the side opposite to the side being examined. The doctor covers the neck with a special gel and then applies the ultrasound head. The examination begins in the supraclavicular area, and then the transducer is gradually moved along the anterolateral part of the neck towards the mandibular angle.
What does the doctor assess during an ultrasound examination?
The doctor assesses the vessels:
common carotid arteries,
internal carotid arteries,
external carotid arteries,
vertebral arteries.
Assessment of atherosclerotic plaque
An atherosclerotic plaque is defined as an ultrasound image of a vessel wall thickening greater than 1.5 mm. The doctor measures the thickness of the artery wall and the length of the section where the abnormalities are observed. This allows you to assess the progress of atherosclerotic changes in subsequent USG examinations or to plan a surgical procedure. The doctor also determines the echogenicity of the atherosclerotic plaque - the presence of an irregular surface increases the risk of plaque detachment and the formation of an embolus.
Artery stenosis - hemodynamic evaluation
The haemodynamic assessment is used to functionally define cerebral circulation disorders. There are, inter alia, measurements of the velocity of blood flowing in the vessels of the head. The measurement takes place at an angle of 60 ° between the ultrasound waveform and the axis of the blood stream flowing in the artery.
Based on ultrasound data, patients are classified into one of three groups:
narrowing of the artery below 50%, no surgical intervention is required,
artery stenosis between 50% and 70%, surgery is required in some cases,
artery stenosis greater than 70%, surgical intervention is the treatment of choice.
Obstruction of the cerebral arteries
Lack of blood flow in the vessel means its obstruction. The image of the early stage of vessel obstruction is characterized by a high differentiation of the echogenicity of atherosclerotic plaques with visible hypoechoic thrombi. With the fibrosis of the lesions, echogenicity increases and the arteries become more difficult to visualize.
Assessment of the common carotid arteries
In the area below 1 cm from the bifurcation of the common carotid artery into the external and internal carotid artery, the thickness of the so-called intima-media complex. It is the middle part of the artery wall along with the inner membrane. The doctor assesses the thickness of the intima-media complex of the common carotid artery, relating the obtained result to specific age norms.
Source:
Elwertowski M, Małek G, Standardy badań ultrasonograficznych Polskiego Towarzystwa Ultrasonograficznego – aktualizacja. Badanie zewnątrzczaszkowych odcinków tętnic szyjnych oraz kręgowych. Journal of Ultrasonography 2014; 14: 179-191.
Frequently asked questions about ultrasound of the carotid and vertebral arteries:
Carotid ultrasound examination is recommended in patients with an increased risk of ischemic stroke. People suffering from frequent headaches, dizziness, fainting, and especially patients with hypertension, diabetes and / or atherosclerosis should undergo it. Periodic control of the condition of the carotid arteries is indicated in people who have suffered an ischemic stroke or in the case of the so-called transient ischemic attacks (TIA). Doppler ultrasound is also used to assess the effects of treatment after surgical plaque removal.
An ultrasound scan detects abnormal blood flow in the arteries that supply blood to the brain. Ultrasound shows atherosclerotic plaques that are a potential source of embolic material. Thanks to this, it is possible to diagnose an increased risk of ischemic stroke early. Ultrasound examination enables regular monitoring of the patient's condition and modification of the treatment method depending on the advancement of changes in the arteries.
Ultrasound examination of the cerebral (cervical and vertebral) arteries does not require special preparation. It is necessary to expose the neck and the area above the collarbones, so it is worth taking care of a comfortable outfit (e.g. a buttoned blouse). If the ultrasound is performed again, bring your previous test results with you.
