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. 2015 Sep;24(3):179-84.
doi: 10.1055/s-0035-1556056. Epub 2015 Jul 15.

Multimodality Imaging of Carotid Stenosis

Theodor Adla  1 , Radka Adlova  2
Affiliations

Multimodality Imaging of Carotid Stenosis

Theodor Adla et al. Int J Angiol. 2015 Sep.

Abstract

Four diagnostic modalities are used to image the following internal carotid artery: digital subtraction angiography (DSA), duplex ultrasound (DUS), computed tomography angiography (CTA), and magnetic resonance angiography (MRA). The aim of this article is to describe the potentials of these techniques and to discuss their advantages and disadvantages. Invasive DSA is still considered the gold standard and is an indivisible part of the carotid stenting procedure. DUS is an inexpensive but operator-dependent tool with limited visibility of the carotid artery course. Conversely, CTA and MRA allow assessment of the carotid artery from the aortic arch to intracranial parts. The disadvantages of CTA are radiation and iodine contrast medium administration. MRA is without radiation but contrast-enhanced MRA is more accurate than noncontrast MRA. The choice of methods depends on the clinical indications and the availability of methods in individual centers. However, the general approach to patient with suspected carotid artery stenosis is to first perform DUS and then other noninvasive methods such as CTA, MRA, or transcranial Doppler US.

Keywords: carotid artery stenosis; computed tomography angiography; digital subtraction angiography; duplex ultrasound; magnetic resonance angiography.

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Figures

Fig. 1
Fig. 1
Digital subtraction angiography of the carotid artery with stenosis more than 70% (arrow) in (A) lateral and (B) anteroposterior view. Stenosis is clearly visible in lateral view bud obscured by external carotid artery in anteroposterior view.
Fig. 2
Fig. 2
Methods of the measurement of the carotid artery stenosis severity: The North American Symptomatic Carotid Endarterectomy Trial (NASCET), European Carotid Surgery Trial (ESCT), and common carotid (CC) method. CCA, common carotid artery; ECA, external carotid artery; ICA, internal carotid artery.
Fig. 3
Fig. 3
(A) Grayscale ultrasound (US) with mixed plaque in the internal carotid artery (arrow). (B) Color and pulse Doppler US with peak systolic velocity 217 cm/s in the internal carotid artery (stenosis 50–69%). L-ICA, left internal carotid artery.
Fig. 4
Fig. 4
Computed tomography angiography with mixed plaque in the internal carotid artery and stenosis (arrows). (A) Volume rendering technique, (B) curved multiplanar reconstruction, and (C) curved multiplanar reconstruction with stenosis measurement using North American Symptomatic Carotid Endarterectomy Trial method.
Fig. 5
Fig. 5
Computed tomography angiography cross-sectional images perpendicular to the longitudinal axis of the internal carotid artery with plaque analysis. (A) Source image. (B) Same image with superimposed color map based on density; red represents lipid core, green fibrous tissue, and blue calcifications.
Fig. 6
Fig. 6
Contrast-enhanced magnetic resonance angiography with the internal carotid artery stenosis more than 70% (arrow). (A) Volume rendering technique, and (B) maximum intensity projection reconstructions.
See this image and copyright information in PMC

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