Author + information
- Received June 19, 2013
- Revision received September 5, 2013
- Accepted September 19, 2013
- Published online February 1, 2014.
- Surabhi Madhwal, MD∗,
- Sandra Yesenko, RVT†,
- Esther Soo Hyun Kim, MD†,
- Margaret Park, RDCS, RVT‡,
- Susan M. Begelman, MD§ and
- Heather L. Gornik, MD, MHS†∗ ()
- ∗Department of Cardiovascular Medicine, Mt. Sinai Medical Center, New York, New York
- †Non-Invasive Vascular Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ‡Echocardiography Laboratory, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- §Genentech, Inc., South San Francisco, California
- ↵∗Address for correspondence:
Dr. Heather L. Gornik, Non-Invasive Vascular Laboratory, Cleveland Clinic Heart and Vascular Institute, 9500 Euclid Avenue, Desk J35, Cleveland, Ohio 44195.
carotid duplex ultrasound (CDUS), combining gray-scale (b mode) and color and spectral (pulsed-wave) Doppler, has become the modality of choice for the initial evaluation and surveillance of extracranial carotid artery disease, with a reported accuracy for the detection of carotid stenosis exceeding 90% (1).
The assessment of carotid artery stenosis severity using CDUS is largely dependent on the pattern and velocities of blood flow within the carotid arteries, with the peak systolic velocity (PSV) in the internal carotid artery generally serving as the primary diagnostic parameter. There are a number of cardiac disorders that can affect flow velocities and Doppler waveforms within the cerebrovasculature. It is important to recognize these disorders for multiple reasons, including the potential to inaccurately diagnose carotid artery stenosis. In addition, as CDUS may be obtained for the evaluation of nonspecific symptoms, such as dizziness or syncope, it may be possible to identify clues to the presence of a cardiac etiology through careful assessment of the Doppler waveforms. The sonographic clues on a CDUS examination that suggest an underlying cardiac disorder include abnormal spectral Doppler waveform morphology, waveform abnormality in multiple vessels (e.g., common/internal carotid and vertebral arteries), waveform abnormality bilaterally, and unusually low or high velocities in the absence of significant vascular lesions on color and/or gray-scale imaging.
Dr. Kim has served as a consultant for Philips Ultrasound and has received research support from GE Healthcare. Dr. Begelman is a paid employee of Genentech. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 19, 2013.
- Revision received September 5, 2013.
- Accepted September 19, 2013.
- American College of Cardiology Foundation