Colour Doppler evaluation of extracranial carotid artery in patients presenting with features of cerebrovascular disease: A clinical and radiological correlation

Aim: To evaluate the morphological and hemodynamic changes that take place in carotid arteries by colour Doppler in patients presenting with features of stroke. Background and Objectives: Cerebrovascular accidents constitute a major cause of adult mortality. The principal indication for cerebrovascular Doppler examination is stroke prevention. Colour Doppler sonography is a sensitive method for detection of atherosclerotic plaque and provides considerable information about the extent and severity of plaque as well as the resulting diminution of arterial lumen. The main strengths of sonography of carotid arteries are patient comfort, lack of risk and accuracy in detecting carotid stenosis. Material and Methods: A prospective study of Colour Doppler in carotid arteries was carried out for 12 months from 1 st July 2009 to 1 st July 2010. The study was carried out on 40 individuals, suspected of cerebrovascular insufficiency and having one or the other risk factors for cerebrovascular disease. A detailed clinical history, CNS examination findings and evidence of hypertension, diabetes mellitus, hyperlipidemia and ischemic heart disease were noted. Carotid Doppler evaluation was done by using Siemens Antares Ultrasound system. The data gathered were grey scale and Doppler findings of common carotid artery, internal carotid artery and external carotid arteries. Doppler findings were correlated with clinical features and risk factors. Results: In our study of 40 patients, the commonest lesion found was the atherosclerotic plaque. Highest incidence of plaque was seen in males 41% in the age group of 60-70 years and in females 37% in age group of 70-80 years. Cigarette smoking was the most common risk factor (60%) associated with stroke/ Transient Ischaemic Attacks (TIA). Hemiparesis was the most common presenting symptom (35%) among the symptomatic cases. Atheromatous plaque was most commonly found in the right carotid system (60%). Most common site for atheromatous plaque was found to be carotid bifurcation (33.3%). Significant stenosis, i.e., >50% was found in 12 (60%) of the cases. Peak systolic velocity ratio showed significant stenosis in 12 (60%) of symptomatic cases and in 4 (20%) of asymptomatic controls. Plaque characteristics showed 9 hyperechogenic, 8 calcific, 4 low echogenic and 5 moderate or heterogeneous plaques. Conclusion: The role of carotid Doppler in detecting the site and morphology of atherosclerotic plaque with quantifying the amount of stenosis is very well-justified. In addition carotid Doppler can also be used to assess the prognosis in potential symptomatic and asymptomatic patients with one or the other risk factors for cerebrovascular disease.