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Research ArticleHead and Neck Imaging

Evaluation of Distal Extracranial Internal Carotid Artery by Transoral Carotid Ultrasonography in Patients with Severe Carotid Stenosis

Kazuhiro Kishikawa, Masahiro Kamouchi, Yasushi Okada, Tooru Inoue, Setsuro Ibayashi and Mitsuo Iida
American Journal of Neuroradiology June 2002, 23 (6) 924-928;
Kazuhiro Kishikawa
aDepartment of Cerebrovascular Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Masahiro Kamouchi
aDepartment of Cerebrovascular Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Yasushi Okada
aDepartment of Cerebrovascular Disease, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Tooru Inoue
bDepartment of Neurosurgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Setsuro Ibayashi
cDepartment of National Kyushu Medical Center, and the Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Mitsuo Iida
cDepartment of National Kyushu Medical Center, and the Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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  • Fig 1.
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    Fig 1.

    Angiographic and ultrasonographic findings of carotid arteries before (left panels) and after (right panels) CEA. Arrowheads indicate severe stenosis in the origin of the ICA. Note that the distal ICA dilated after CEA.

    A, Angiographic findings before CEA.

    B, TOCU findings before CEA.

    C, Conventional carotid ultrasonographic findings before CEA.

    D, Angiographic findings after CEA.

    E, Transoral carotic ultrasonographic findings after CEA.

    F, Conventional carotd ultrasonographic findings after CEA.

  • Fig 2.
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    Fig 2.

    Diameter of the distal ICA before and after CEA is plotted. Diameter was measured intraorally at the level of the post-pharyngeal portion by using TOCU. Closed circles and error bars indicate mean ± SD.

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    Fig 3.

    Comparison of the percent increase in the diameter of the distal ICA as estimated by TOCU and cerebral angiography.

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    Fig 4.

    Relationship between degree of carotid stenosis and postoperative dilatation of the ICA. Percent increase in the diameter of the distal ICA was plotted against the grade of carotid stenosis. Grade of carotid stenosis in a cross-sectional area was estimated by conventional carotid ultrasonography. Diameter of the distal ICA was estimated by TOCU. Dotted line indicates 95% stenosis.

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    Fig 5.

    Relationship between preoperative diameter and postoperative dilatation of the ICA. Percent increase in the diameter of the distal ICA was plotted against the preoperative diameter of the distal ICA. Diameter of the distal ICA was estimated by TOCU. Dotted line indicates diameter of 3.0 mm.

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    TABLE 1:

    Demographic and clinical characteristics

    Age (years)67.6 ± 6.6 
    Male:Female (n)17:3
    Degree of stenosis (%)74.9 ± 14.6
    Symptomatic attack19/20 (95%)
     Minor stroke8/20 (40%)
     Transient ischemic attack11/20 (55%)
    Risk factors
     Hypertension16/20 (80%)
     Smoking15/20 (75%)
     Hyperlipidemia11/20 (55%)
     Diabetes mellitus7/20 (35%)
    Vascular complications
     Ischemic heart disease7/20 (35%)
     Arteriosclerosis obliterans2/20 (10%)
    • Note.—Values are expressed as mean ± SD. The degree of carotid stenosis was calculated using the method described by the North American Symptomatic Carotid Endarterectomy Trial group 1. Ischemic heart disease was diagnosed by myocardial scintigraphy, and arteriosclerosis obliterans was diagnosed by ankle pressure index, pulse wave, and clinical symptoms.

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    TABLE 2:

    Change in parameters before and after carotid endarterectomy

    PreoperationPostoperationP
    Angiography
     ICA:CCA0.51 ± 0.160.59 ± 0.14<0.01
    TOCU
     B mode
      Diameter (mm)3.5 ± 0.83.9 ± 0.5<0.01
     Flow velocity (cm/s)
      Peak systolic velocity69.2 ± 25.671.5 ± 20.9NS
      End-diastolic velocity23.8 ± 7.124.2 ± 7.1NS
      Mean flow velocity38.8 ± 12.240.7 ± 11.8NS
    • Note.—ICA indicates internal carotid artery; CCA, common carotid artery; TOCU, transoral carotid ultrasonography; NS, not significant. Values are mean ± SD. P values exceeding .05 were considered to be significant. ICA:CCA indicates the ratio of the diameter of the internal carotid artery to that of the common carotid artery. The flow velocity of the distal internal carotid artery was obtained by transoral carotid ultrasonography.

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American Journal of Neuroradiology: 23 (6)
American Journal of Neuroradiology
Vol. 23, Issue 6
1 Jun 2002
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Cite this article
Kazuhiro Kishikawa, Masahiro Kamouchi, Yasushi Okada, Tooru Inoue, Setsuro Ibayashi, Mitsuo Iida
Evaluation of Distal Extracranial Internal Carotid Artery by Transoral Carotid Ultrasonography in Patients with Severe Carotid Stenosis
American Journal of Neuroradiology Jun 2002, 23 (6) 924-928;

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Evaluation of Distal Extracranial Internal Carotid Artery by Transoral Carotid Ultrasonography in Patients with Severe Carotid Stenosis
Kazuhiro Kishikawa, Masahiro Kamouchi, Yasushi Okada, Tooru Inoue, Setsuro Ibayashi, Mitsuo Iida
American Journal of Neuroradiology Jun 2002, 23 (6) 924-928;
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