engleski

Ultrasound diagnostic in Carotid Artery Disease

Stroke is an urgent condition requiring emergent management, with high death and disability rate. Neurosonology offers a variety of diagnostic procedures to define stroke types and subtypes, and the risk of recurrence. In asymptomatic individuals macroangiopathic changes of the head and neck can be detected, aiming early interventional measures in stroke prevention. Ultrasound is a noninvasive method, which can define with high accuracy the mechanism of stroke. By means of extracranial carotid and vertebral color Doppler flow imaging, the appearance and type of atherosclerotic plaques can be visualized. Detailed analysis can define plaque echogenicity that is related to plaque composition. Plaque surface as regular, irregular or ulcers can be differentiated. The degree of stenosis can be assessed accurately, and in most patients the need for angiography is eliminated. Other types of inflammatory neurovascular diseases can be also visualized, as well as the nonatherosclerotic vasculopathies and dissections, which can develop independently of afore mentioned diseases. High-resolution ultrasound provides information on intima-media thickness, which is an important risk factor for stroke, especially ischemic stroke, and also for myocardial infarction. By means of transcranial Doppler intracranial hemodynamic can be assessed. The exact localization of the artery stenosis or occlusion can be detected, and recanalization monitoring is possible. Hemodynamic redistribution in extra or intracranial occlusive disease can be registered, providing information of activation of anterior, posterior collateral pathways or activation of cortical collaterals. The collateral pathway through the ophthalmic artery is the last collateral pathway associated with the worse prognosis. In patients with carotid artery stenosis vasoreactivity testing is important in assessment of operative risk. The development of software enabled high intensity transient signals (HITS) registration, providing additional information of carotid plaques stability. The development of ultrasonographic techniques enables easy and noninvasive complete vascular assessment of stroke patients and of asymptomatic individuals with risk factors.

stroke; carotid artery disease; atherosclerotic plaque

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