Carotid Ultrasound - MY CONCIERGE MD

What Is A Carotid Ultrasound Test?

The carotid arteries are located on both the right and left sides of the neck and are responsible for providing blood supply to the brain. The carotid arteries branch off into two vessels known as the external and internal carotid arteries and distribute blood flow to designated areas inside the brain. A carotid ultrasound or carotid artery test uses sound waves to visualize the blood flow throughout the carotid arteries and evaluates narrowing or plaque buildup inside the vessel wall.

Our Beverly Hills medical practice is equipped with an advanced duplex ultrasound to perform carotid ultrasound testing as well as a variety of other diagnostic sonographic tests. Contact our office today to schedule your test today! We also have mobile ultrasound technologist that can perform ultrasound testing in the comfort of your home or desired location.

Duplex Ultrasound

Duplex ultrasound, also known as duplex scan or duplex sonography, is a non-invasive medical imaging test that uses high-frequency sound waves to create detailed images of the blood vessels. It combines traditional ultrasound imaging with Doppler ultrasound technology, which measures the direction and speed of blood flow.

Duplex ultrasound is used to evaluate the blood flow in a variety of vessels in the body, such as the carotid arteries in the neck, the renal (kidney) arteries, the aorta, the leg vessels and others. It is particularly useful in detecting blockages or other abnormalities in the blood vessels, such as an aneurysm, a clot, or plaque buildup. It can also detect blood flow problems, such as insufficient blood flow to an organ, and can also be used to measure blood flow velocities and arterial stenosis (narrowing).

The test is non-invasive and painless and can be done in an outpatient setting. The test typically takes between 30 to 60 minutes and does not require any preparation other than avoiding food and drink for a few hours prior to the test.

Duplex ultrasound can provide important information for the diagnosis and management of vascular diseases, and its results will be interpreted and discussed by a radiologist with the patient’s clinician, who will integrate the results in their overall clinical evaluation.

Reasons for carotid ultrasound?

The purpose of having an ultrasound of the carotid arteries or carotid duplex exam is to evaluate the vessel anatomy. Early detection of pathology within the vessel walls can aid in early treatment and prevent strokes and other complications. Patients who have experienced transient ischemic attacks, dizziness, have nearly passed out or have had episodes of passing out may have abnormalities in these vessels.

Indications for Carotid Ultrasound testing:

  • Hypertension
  • Dizziness
  • Near Syncope
  • History of Elevated Cholesterol Levels
  • History of Tobacco Use
  • Syncope
  • Transient Ischemic Attacks
  • Family history of carotid artery abnormalities
  • History of heart disease

Carotid Angiography vs Carotid Ultrasound

Carotid angiography and carotid ultrasound are both diagnostic tests used to evaluate the condition of the carotid arteries and detect any blockages or other abnormalities.

Carotid ultrasound is a non-invasive test that uses high-frequency sound waves to create images of the carotid arteries. It is typically the first line of evaluation for carotid artery disease because of its non-invasive nature and lack of radiation exposure. It is relatively easy to perform and can be done quickly in an outpatient setting. It allows for measurement of intima-media thickness, luminal diameter, blood flow, and plaque presence.

Carotid angiography, on the other hand, uses X-ray imaging to create detailed pictures of the carotid arteries after injecting a contrast dye. It is considered an invasive test as it require an injection of contrast material and exposes the patient to a small amount of radiation. However, the angiography offers higher resolution images and can be used to guide certain therapeutic interventions.

In general, carotid ultrasound is considered the first-line screening test for carotid artery disease and is used to evaluate the severity of the stenosis, while carotid angiography is considered a more invasive and specialized test, used in more complex cases and/or when ultrasound results are inconclusive. The decision of which test to use is usually determined by the physician after a thorough evaluation of patient’s symptoms, medical history and risk factors. Our physician can guide you in regards to which test and if you need further testing to evaluate your vertebral arteries.

What Is The Prep For a Carotid Ultrasound?

A carotid ultrasound or carotid artery ultrasound is a non-invasive test that uses sound waves to create images of the carotid arteries, which are the major blood vessels on the side of your neck that supply blood to the brain. The test is typically performed to check for blockages, carotid plaque, or narrowing of the carotid arteries that can increase the risk of stroke.

The preparation for a carotid ultrasound typically involves the following:

  • Fasting: You may be asked not to eat or drink anything for a certain period of time before the test, typically 4 to 6 hours.
  • Clothing: You may be asked to wear loose and comfortable clothing, as the ultrasound transducer needs to be placed directly on the skin over the carotid artery.
  • Medications: You should inform your doctor of any medications you are currently taking, as some medications, such as blood thinners, may need to be stopped before the test.
  • Avoiding certain activities: You may be advised to avoid activities such as heavy exercise or smoking for several hours before the test, as these activities can affect blood flow and may interfere with the results.

How Is A Carotid Ultrasound Performed?

During the test, a gel will be applied to the skin over the carotid artery and a transducer (a small handheld device) will be moved over the skin to create images of the artery. The test is usually painless, and takes around 30-45 minutes. An ultrasound technician places a high frequency transducer on the carotid arteries and the ultrasound machine produces a live image of the vessels.

The blood flow within the arteries as well as the thickness, diameter, plaque buildup is then measured. Carotid Doppler is able to obtain Doppler Velocity of the blood flow within the vessel and help rule out signs of blockage, stenosis or intima wall thickening.

It’s important to inform your doctor of any allergies or medical conditions you have, and any medications you take, in order to ensure the test can be performed safely and the results are accurate. Our medical team will follow up with you in regards to your results and management.

Carotid Artery Blockage Symptoms

Many patients may not have any signs or symptoms of blocked carotid arteries till they manifest with more serious symptoms. Signs of narrowing of the carotid vessels may be an abnormal sound such as a bruits or a murmur heard by a physician while a stethoscope is placed over the carotids. Symptoms of narrowing of the neck arteries can range from sudden numbness or weakness in the extremities or the face, sudden difficulty with speech, dizziness, loss of balance and more.

Benefits Of a Carotid Ultrasound Scan

An easy and safe method to evaluate risk of stroke and diagnose a variety of conditions associated with carotid abnormality. Whether there is a history of smoking, hypertension, hyperlipidemia or dizziness, an ultrasound can help visualize plaque buildup, narrowing within the vessels and help decrease stroke risk. You do not need to be referred to a radiology center to perform your test, our office is equipped with an ultrasound technician as well as the latest ultrasound diagnostic equipment.

What Are Normal Results From A Carotid Ultrasound?

Normal results from a carotid artery ultrasound will show clear, unobstructed blood flow through the carotid arteries and no significant buildup of plaque. The walls of the arteries will appear smooth, without any visible bulges or irregularities. The test will also measure the blood flow through the arteries and should be within normal range.

However, please note that the ultrasound technician will usually report any abnormalities to the physician and it will require clinical evaluation and interpretation.

carotid ultrasound measurements

A carotid ultrasound typically measures the following parameters:

  1. Intima-media thickness (IMT): The thickness of the innermost two layers of the carotid artery wall. Increased IMT is considered a marker of early atherosclerosis.
  2. Plaque presence: The presence and location of any plaque buildup in the carotid arteries. Plaque is a buildup of fatty material, calcium, and other substances in the walls of the arteries.
  3. Luminal diameter: The width of the interior of the carotid artery, which indicates the degree of narrowing or blockage of the artery.
  4. Blood flow: The speed and direction of blood flow through the carotid arteries. This can be measured using Doppler ultrasound.
  5. Stenosis: The degree to which an artery is narrowed or blocked. This can be estimated by comparing the measurements of the affected artery to those of a normal artery.

Please note that these measurements will be used in combination with patient’s symptoms, medical history, and other examination results by the clinician to evaluate the overall condition of the carotid artery and plan treatment accordingly.

Carotid Artery Stenosis

Carotid artery stenosis is a condition in which the carotid artery, which supplies blood to the brain, becomes narrowed or blocked by plaque buildup, also called atherosclerosis. When plaque builds up in the carotid artery, it is called carotid artery disease or carotid artery stenosis.

Carotid artery stenosis can cause a reduction in blood flow to the brain, which can increase the risk of stroke. Symptoms of carotid artery stenosis may include mini-strokes, also known as Transient Ischemic Attacks (TIA), or amaurosis fugax (temporary vision loss). However, most of the time, carotid artery stenosis does not cause any symptoms, which is why it may be known as a silent disease.

There are multiple tests to diagnose carotid artery stenosis, and it is usually identified by carotid ultrasound, which can determine the extent of stenosis. The severity of the stenosis is usually expressed as a percentage, based on the ratio of the narrowed area to the normal area of the carotid artery.

Treatment for carotid artery stenosis depends on the severity of the stenosis, symptoms and patient’s overall health and medical history. Medical management is usually recommended for mild to moderate stenosis, while endovascular procedures or carotid endarterectomy may be used for moderate to severe stenosis, or when the patient is at high risk of stroke. As I explained earlier, lifestyle changes such as eating a healthy diet, exercising regularly, quitting smoking, and maintaining a healthy weight, will also help reduce the risk of developing carotid artery stenosis, and help manage it.

Treatment For Carotid Blockage

Treatment for carotid artery blockage depends on the severity of the blockage and the patient’s overall health and medical history. In general, treatment options include:

  1. Medical management: For patients with mild to moderate blockages, doctors may recommend medications to lower cholesterol and blood pressure, and to reduce the risk of blood clots. These medications include statins, blood thinners, and anti-platelet drugs.
  2. Endovascular procedures: For patients with moderate to severe blockages who are not suitable for surgery, doctors may recommend an endovascular procedure such as carotid artery stenting. This procedure involves threading a small wire mesh tube (stent) into the blocked carotid artery to keep it open.
  3. Carotid endarterectomy: For patients with severe blockages or a high risk of stroke, a carotid endarterectomy may be recommended. This is a surgical procedure that removes the plaque buildup from inside the carotid artery to restore normal blood flow.

The best treatment option will be determined by the clinical condition of the individual patient, after clinical evaluation and discussion with the treating physician.

Treatment For Carotid Blockage - MY CONCIERGE MD

It is also important to note that lifestyle changes such as eating a healthy diet, exercising regularly, quitting smoking, and maintaining a healthy weight, will also help reduce the risk of developing carotid artery blockage, and help manage it.

Carotid Endarterectomy

Carotid endarterectomy is a surgical procedure used to remove plaque buildup from the inside of the carotid arteries in the neck. The procedure is done to reduce the risk of stroke caused by a blockage in the carotid artery.

During the procedure, a surgical incision is made in the neck, and the surgeon carefully opens the carotid artery to remove the plaque and any other debris that may be present. The artery is then closed with sutures or a patch, and the incision is closed with stitches or staples.

Carotid endarterectomy is typically performed on patients who have severe blockages in their carotid arteries, or who have had symptoms such as stroke, mini-stroke (transient ischemic attack), or amaurosis fugax (temporary vision loss).

The procedure is done under general anesthesia, in which a patient is asleep throughout the operation. The procedure is usually done on an outpatient basis, and patients are usually able to return to their normal activities within a few days. However, it can have some risks and complications, like any other surgical procedure, such as bleeding, infection, nerve injury and stroke. Your surgeon will provide you with more information on this.

Carotid Angioplasty

Carotid angioplasty, also known as carotid artery stenting, is a minimally invasive endovascular procedure used to treat carotid artery stenosis. It is a procedure used to open a narrowed or blocked carotid artery, which is the major blood vessels in the neck that supply blood to the brain.

During the procedure, a thin tube called a catheter is inserted into the artery through a small incision in the groin. The catheter is then guided to the narrowed or blocked area of the carotid artery. A small wire mesh tube called a stent is then placed inside the narrowed section of the carotid artery to hold the artery open.

Carotid angioplasty is performed under local anesthesia and is typically done in an outpatient setting. The procedure is done in a specialized facility equipped with X-ray equipment, so that the physician can monitor the procedure in real-time.

The advantage of carotid angioplasty is that it is a less invasive alternative to surgery and patients usually have a quicker recovery. It can be considered for patients who have moderate to severe stenosis and are not suitable for surgery or for those who wish to avoid it.

As with any medical procedure, there are risks associated with carotid angioplasty, such as bleeding, infection, allergic reactions, and others. The risk of complications will be discussed with the patient before the procedure.

Relationship Between Carotid Stenosis And Coronary Artery Disease

Carotid stenosis and coronary artery disease (CAD) are two separate conditions that affect different parts of the body, but there is a strong association between the two. Carotid stenosis refers to the narrowing of the carotid artery, which supplies blood to the brain, while CAD refers to the narrowing of the coronary artery, which supplies blood to the heart.

Atherosclerosis, which is the buildup of plaque in the walls of the arteries, is the primary cause of both conditions. Plaque buildup in the carotid artery can lead to carotid stenosis, while plaque buildup in the coronary artery can lead to CAD. Because of this shared underlying cause, people with carotid stenosis are at an increased risk of developing CAD and vice versa.

Both carotid stenosis and CAD are also associated with several common risk factors such as high blood pressure, high cholesterol, smoking, diabetes, and a sedentary lifestyle. Therefore, people who have risk factors for carotid stenosis and CAD are at a higher risk of developing both conditions.

The relationship between carotid stenosis and CAD highlights the importance of identifying and managing the common risk factors for both conditions, including managing blood pressure and cholesterol levels, maintaining a healthy lifestyle, and early detection of either condition. This can help prevent the development or progression of both diseases and reduce the risk of stroke and heart attacks.

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