Carotid Imaging Modalities. Kyle Boyce August 3, 2007. Leading Causes of Death in U.S. 1. Heart Disease 2. Cancer 3. Stroke (2 nd leading cause Worldwide) Carotid Artery Atherosclerosis – 7% of patients presenting with initial stroke. Non-modifiable Age Race Gender Family History
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August 3, 2007
Low FolateRisk Factors
Currently, three methods (NASCET, ECST and CC) predominate worldwide.
High Sensitivity and Specificity for significant stenosis (70-99%)
Overestimates the degree of stenosis
May miss hairline lumens
LimitationsCarotid Duplex U/S
anatomical detail of blood vessels more precisely than MRA or U/S
CI in pt’s with renal insufficiency or severe DM
Risk of Allergic rxn
Radiation exposureCT Angiography
The electromagnetic energy that is released when exposing a patient to radiofrequency waves in a strong magnetic field is measured and analyzed by a computer
Most often used for evaluating the extracranial carotid arteries.
Utilize either three dimensional time-of-flight MRA or gadolinium-enhanced MRA (contrast enhanced MRA).
Great imaging w/o use of contrast or radiation
CEMRA – higher quality image with less artifact
No catheter in area of interest
May be most accurate non-invasive method
May overestimate degree & length of stenosis? Use NASCET
CI for pt’s with metallic implants
CI in patients with renal insufficiencyMagnetic Resonance Angiography
Evaluates entire carotid a. system
Information about the disease process
Potential for stroke
Limited views of carotid & bifurcationCerebral Angiography
CEA more beneficial for asymp men
with 60-99% stenosis who are
good surgical candidates
May be benefit with 50 to 69% symptomatic stenosis (clearly shown in men but not women)