[Ultrasonic study of 22 cases of carotid artery dissection]

Abstract

The purpose of this study was to assess the value of duplex scanning and continuous wave Doppler velocimetry in the diagnosis and follow-up of ICA dissections. Between 1975 and 1988, 20 patients (11 women and 9 men; mean age 45 years) were admitted to the University Hospital of Angers for dissection of the ICA confirmed by angiography. The dissections were unrelated to direct cervical injury and were unilateral in 18 cases and bilateral in 2 cases. Six patients experienced transient cerebral ischaemic accidents (later completed in 2 cases) and 2 patients merely complained of ocular disorders of sympathetic origin. Fourteen patients were treated with heparin. All patients were examined by continuous wave Doppler ultrasound followed by duplex scanning. These examinations were performed 10 days on average before angiography. Continuous wave Doppler revealed signs of obstruction of the ICA in 95% of the cases: occlusion in 4 cases, tight stenosis in 13 cases and marked slowing of blood flow in the carotid and ophthalmic arteries in 4 cases. The acoustic signs of high or extensive ICA stenosis with reduced or retrograde ophthalmic artery blood flow were fairly suggestive of dissection. These results were completed by mode B which showed signs of dissection in 61% of the cases (tapering stenosis or occlusion, tubular ICA, separation of the vascular walls on rare occasions) and excluded atheromatous lesions in 81% of the patients. The tubular ICA image being non-specific was interpreted in relation to the clinical context and haemodynamic data, after discussion and exclusion of fibromuscular dysplasia, intracranial carotid stenosis causing severe reduction of blood flow and the exceptional hypoplasia of the ICA.(ABSTRACT TRUNCATED AT 250 WORDS)