Ignite Creation Date:
2024-05-06 @ 7:11 PM
Last Modification Date:
2024-10-26 @ 3:01 PM
Study NCT ID:
NCT05920291
Status:
NOT_YET_RECRUITING
Last Update Posted:
2023-06-27
First Post:
2023-04-05
Brief Title:
Carotid Doppler Findings of High Risk Group of Stroke
Sponsor:
Assiut University
Organization:
Assiut University
Study Overview
Official Title:
The Predictive Value of Carotid Doppler Ultrasound Findings for Stroke Risk Assessmen
Status:
NOT_YET_RECRUITING
Status Verified Date:
2023-06
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
To evaluate the effect of different risk factors on carotid arteries via ultrasonography parameters
Detailed Description:
Atherosclerosis of carotid arteries is a common serious condition that develops when sticky plaque builds up inside carotid arteries that deliver blood to brain so carotid artery diseases cause about 10-20 percent of strokes which is a medical emergency that can leave the brain with permanent damage
Doppler sonography of the cervical segment of carotid arteries is a popular non-invasive tool for evaluation of anatomy and hemodynamics of carotid artery 1 its ability to measure intimal media thickening and characterizes the morphology of carotid atheroma makes it a reliable modality to determine the etiology and severity of stroke 3 4 Carotid intimal media thickening is measured as the distance between the leading edges of the two echogenic layers of the wall using the posterior wall 5 in addition color Doppler ultrasonography permits measurement of flow based on reflection of ultrasound waves utilizing both pulse Doppler and color Doppler ultrasound Visualization of color coded flow information about direction and velocity so with high grade lesions are more easily detected with color than with pulsed Doppler ultrasound although the later allows direct estimation of flow velocity The peak systolic velocity PSV is used for quantification of stenosis however end diastolic velocity EDV carotid index and spectral wave form analysis are also used for assessment of stenosis 6
Also color integration is used to identify areas of abnormal flow There are a number of pitfalls when using velocity based estimation of ICA stenosis such as higher velocities in females and elevated velocities where theres contra lateral carotid artery occlusion 7_9 If there is a severe tortuosity of an artery high carotid bifurcation obesity or extensive calcification of the vasculature these will reduce the sonographic accuracy if carotid artery stents are already in situ vessel wall compliance can be diminished accelerating flow velocity10 Ultrasound may also be unable to distinguish between partial and complete vessel occlusion despite the distinction being critically clinically important 10-12
In this study we present analysis of findings of carotid ultrasound examination among patients with clinical suspicion and risk for cerebrovascular diseases in New Valley
Ultrasonography in this study is used to measure intimal thickening as well as flow characteristics of carotid artery with focus on internal carotid artery
Extra cranial vessels represent vessels outside the brain and the skull The most common configuration is the three-vessel arch anatomy where the first branch is the brachiocephalic artery which further branches into the right common carotid artery CCA and right subclavian artery The second branch is the left common carotid artery with the left subclavian artery as the third branch 13 The most common variant to this anatomy is the common origin of brachiocephalic and left CCA from aortic arch The common carotid arteries bifurcate into the external carotid artery ECA and internal carotid artery ICAat the upper border of the thyroid The carotid bulb is the location of a bifurcation and the ICA origin 14 ICA is generally posterior and lateral to ECA and is usually bigger in caliber compared to ECA ECA supplies the musculature of face and neck and tapers distally giving off extra cranial branches 15
Coloured Doppler sonography using 5-10 MHZ multifrequency linear transducer the scan is performed in both transverse and longitudinal dimensions
The patients are scanned in supine position on the examination table the patients head is turned away from the side and the neck a little extended The examination is carried out either from the patients Side or sitting at the patients head Coupling gel is applied on each side of the neck
Gray scale imaging which is also Called B brightness mode is usually performed first where the carotid arteries are evaluated in their entirety from the jugular notch to angle of the mandible 16B_mode imaging evaluates the coarse and caliber of the vessel with evaluation of intimal media thickness and quality of the plaque the morphology of the plaque is associated with the severity of atherosclerotic diseases 17 At the jugular notch the transducer angulated caudally while at the mandible its cephalic angulated
This is followed by Doppler examination 1819 Many parameters should be adjusted to achieve reliable results Doppler angle should be less than 60 degrees as close as possible to parallel to improve accuracy of measurements 20 The calculated velocity will be incorrect if calculated using inaccurate angle the velocity of CCA is usually 30-40 cmsec but may vary in diseased vessel 21 Gain is adjusted so that color is seen only within the lumen of the vessel to avoid bleeding artifact 22 Sample volume should be placed in to center of the lumen and should be moved along the entire vessel Any abrupt change in the systolic velocity or area of slow flow should be carefully evaluated and documented123 Spectral analysis including peak systolic velocity PSV peak diastolic velocity PDV main maximum velocity and pulsatiliy index can be obtained Spectral Doppler wave form evaluation gives critical information about flow dynamics at the point of sampling which depends on hemodynamic factors affect proximal and distal portion of the vessel 24 ICA demonstrates low resistance flow ECA has high resistance flow while CCA has a hybrid of ICA and ECA The resistive index is used to describe wave form which signifies resistance of the vessel distal to the examined vessel 25 Spectral Doppler should be evaluated at minimum at a proximal mid and distal common carotid artery b proximal mid and distal internal carotid artery c proximal carotid artery dvertebral artery any significant stenosis should be carefully evaluated and documented distal and proximal to the stenosis2627 Peak systolic velocity PSV greater than 125cmS correlates with 50or higher ICA stenosis 28 PSV greater than 230cms correlates with 70 or higher stenosis a potential indication for surgical endarterectomy
Doppler sonography of the cervical segment of carotid arteries is a popular non-invasive tool for evaluation of anatomy and hemodynamics of carotid artery 1 its ability to measure intimal media thickening and characterizes the morphology of carotid atheroma makes it a reliable modality to determine the etiology and severity of stroke 3 4 Carotid intimal media thickening is measured as the distance between the leading edges of the two echogenic layers of the wall using the posterior wall 5 in addition color Doppler ultrasonography permits measurement of flow based on reflection of ultrasound waves utilizing both pulse Doppler and color Doppler ultrasound Visualization of color coded flow information about direction and velocity so with high grade lesions are more easily detected with color than with pulsed Doppler ultrasound although the later allows direct estimation of flow velocity The peak systolic velocity PSV is used for quantification of stenosis however end diastolic velocity EDV carotid index and spectral wave form analysis are also used for assessment of stenosis 6
Also color integration is used to identify areas of abnormal flow There are a number of pitfalls when using velocity based estimation of ICA stenosis such as higher velocities in females and elevated velocities where theres contra lateral carotid artery occlusion 7_9 If there is a severe tortuosity of an artery high carotid bifurcation obesity or extensive calcification of the vasculature these will reduce the sonographic accuracy if carotid artery stents are already in situ vessel wall compliance can be diminished accelerating flow velocity10 Ultrasound may also be unable to distinguish between partial and complete vessel occlusion despite the distinction being critically clinically important 10-12
In this study we present analysis of findings of carotid ultrasound examination among patients with clinical suspicion and risk for cerebrovascular diseases in New Valley
Ultrasonography in this study is used to measure intimal thickening as well as flow characteristics of carotid artery with focus on internal carotid artery
Extra cranial vessels represent vessels outside the brain and the skull The most common configuration is the three-vessel arch anatomy where the first branch is the brachiocephalic artery which further branches into the right common carotid artery CCA and right subclavian artery The second branch is the left common carotid artery with the left subclavian artery as the third branch 13 The most common variant to this anatomy is the common origin of brachiocephalic and left CCA from aortic arch The common carotid arteries bifurcate into the external carotid artery ECA and internal carotid artery ICAat the upper border of the thyroid The carotid bulb is the location of a bifurcation and the ICA origin 14 ICA is generally posterior and lateral to ECA and is usually bigger in caliber compared to ECA ECA supplies the musculature of face and neck and tapers distally giving off extra cranial branches 15
Coloured Doppler sonography using 5-10 MHZ multifrequency linear transducer the scan is performed in both transverse and longitudinal dimensions
The patients are scanned in supine position on the examination table the patients head is turned away from the side and the neck a little extended The examination is carried out either from the patients Side or sitting at the patients head Coupling gel is applied on each side of the neck
Gray scale imaging which is also Called B brightness mode is usually performed first where the carotid arteries are evaluated in their entirety from the jugular notch to angle of the mandible 16B_mode imaging evaluates the coarse and caliber of the vessel with evaluation of intimal media thickness and quality of the plaque the morphology of the plaque is associated with the severity of atherosclerotic diseases 17 At the jugular notch the transducer angulated caudally while at the mandible its cephalic angulated
This is followed by Doppler examination 1819 Many parameters should be adjusted to achieve reliable results Doppler angle should be less than 60 degrees as close as possible to parallel to improve accuracy of measurements 20 The calculated velocity will be incorrect if calculated using inaccurate angle the velocity of CCA is usually 30-40 cmsec but may vary in diseased vessel 21 Gain is adjusted so that color is seen only within the lumen of the vessel to avoid bleeding artifact 22 Sample volume should be placed in to center of the lumen and should be moved along the entire vessel Any abrupt change in the systolic velocity or area of slow flow should be carefully evaluated and documented123 Spectral analysis including peak systolic velocity PSV peak diastolic velocity PDV main maximum velocity and pulsatiliy index can be obtained Spectral Doppler wave form evaluation gives critical information about flow dynamics at the point of sampling which depends on hemodynamic factors affect proximal and distal portion of the vessel 24 ICA demonstrates low resistance flow ECA has high resistance flow while CCA has a hybrid of ICA and ECA The resistive index is used to describe wave form which signifies resistance of the vessel distal to the examined vessel 25 Spectral Doppler should be evaluated at minimum at a proximal mid and distal common carotid artery b proximal mid and distal internal carotid artery c proximal carotid artery dvertebral artery any significant stenosis should be carefully evaluated and documented distal and proximal to the stenosis2627 Peak systolic velocity PSV greater than 125cmS correlates with 50or higher ICA stenosis 28 PSV greater than 230cms correlates with 70 or higher stenosis a potential indication for surgical endarterectomy
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None