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Journaux
Journal of Ultrasonography
Édition 24 (2024): Edition 96 (February 2024)
Accès libre
Innominate artery occlusion: a case study
Mohamed Nashnoush
Mohamed Nashnoush
,
Hosna Sahak
Hosna Sahak
,
Yoojin Shin
Yoojin Shin
,
Roja Ahimsadasan
Roja Ahimsadasan
,
Yanuga Raveendran
Yanuga Raveendran
,
John Hanna
John Hanna
et
Khulud Nurani
Khulud Nurani
| 27 févr. 2024
Journal of Ultrasonography
Édition 24 (2024): Edition 96 (February 2024)
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Article Category:
Case study
Publié en ligne:
27 févr. 2024
Pages:
-
Reçu:
18 avr. 2023
Accepté:
19 janv. 2024
DOI:
https://doi.org/10.15557/jou.2024.0008
Mots clés
CT
,
brachiocephalic artery occlusion
,
innominate artery occlusion
,
subclavian steal syndrome
,
carotid ultrasound
© 2024 Mohamed Nashnoush et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Fig. 1.
Comparison between the dampened waveform in the proximal RCCA and the normal waveform of the proximal LCCA
Fig. 2.
Dampened right external carotid artery (RECA) waveform with a PSV of 45 cm/s and end-diastolic velocity (EDV) of 28 cm/s compared to the high-resistance left external carotid artery (LECA) waveform
Fig. 3.
Evidence of transient end-diastolic flow reversal and dampening of the waveforms in the distal RICA. The PSV in the RICA does not exceed 23 cm/s in all segments. The proximal left internal carotid artery (LICA) waveform was added for comparison. When imaging the distal ICA, it is important to visualize the parotid gland and to follow the distal ICA, as it dives posteriorly. Increasing the color gain and decreasing the color pulse repetition frequency (PRF) may help visualize the distal ICA
Fig. 4.
Retrograde flow noted in the right vertebral artery with a PSV of 94 cm/s and EDV of 40 cm/s. The left vertebral artery demonstrates antegrade flow with a PSV of 105 cm/s and EDV of 35 cm/s. When the direction of flow is not clear in the vertebral artery, it is advised to document the CCA in split screen, with red representing blood flow towards the brain, and then angling and sliding the probe laterally and posteriorly to image the vertebral artery without changing any of the Doppler parameters. The vertebral vein will be seen anterior to the vertebral artery and may appear pulsatile. It is important not to confuse the two vessels. Both will pass through the transverse foramina of the cervical spine, and it may be easier to distinguish the two by looking for the origin of the vertebral artery off the subclavian artery
Fig. 5.
Occlusion of the innominate artery is demonstrated proximal to the origin of the RCCA and subclavian artery. Lack of enhancement in the innominate artery is demonstrated in all three planes
Fig. 6.
Evident left vertebral dominance alluding to contralateral compensatory flow
Fig. 7.
Moderate stenosis of the supraclinoid RICA is illustrated by the purple arrow, and calcified plaque (blue arrow) is demonstrated at the origin of the RICA (red arrow), causing a 30% diameter lumen reduction
Fig. 8.
Tardus parvus waveform seen in the proximal RCCA
Fig. 9.
Rapid systolic upstroke with a sharp deceleration and diminished forward flow in diastole is characteristic of flow in the LECA. This is in contrast to the prolonged systolic acceleration and rounding of the systolic peak demonstrated in the RECA, consistent with a tardus parvus waveform. Temporal tap was applied on the right side to help distinguish between the RICA and RECA. Reflected waves indicated by the green arrow demonstrate a ‘saw-tooth’ pattern confirming the identification of the ECA
Fig. 10.
Tardus parvus waveform seen in the proximal RICA with spectral broadening. Diminished diastolic flow is seen in all segments of the RICA, signaling a change to high-resistance flow compared to the tardus parvus waveforms visualized in the RECA and RCCA. This may be caused by a moderate stenosis in the intracranial RICA. In the proximal LICA there is a PSV of 255 cm/s indicative of a 50–69% stenosis.
Fig. 11.
Right brachial, radial and ulnar artery waveforms display a rounded peak with a pronounced decrease in amplitude compared to the triphasic left upper extremity waveforms. The difference in brachial pressures across the arms, along with the CW Doppler findings, suggest moderate disease in the right arm. Ankle-brachial indices are in the normal range bilaterally, with multiphasic CW Doppler waveforms.
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