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PSVM CONSENSUS 2019 Carotid Duplex Scan
Ma. Teresa Abola, MD, FPCP, FPCC, FPSVM Lilibeth Maravilla, MD, FPCP, FPCC, FPSVM Patricio Palmes, MD, FPCP, FPCC, FPSVM
Richie Limbungan, MD, FPCC, FPSVM
I. Summary of Criteria for Carotid Stenosis: ICA, NON-ICA and Vertebral
artery. II. Image Gallery:
a. Normal Cerebrovascular Waveforms. i. Normal CCA ii. Normal ECA iii. Normal proximal ICA iv. Normal mid-ICA v. Normal distal-ICA
b. Abnormal Cerebrovascular Waveforms. i. ICA near occlusion (“String sign”) ii. ICA with distal ICA stenosis. iii. ECA stenosis. iv. ECA with reversed flow due to CCA occlusion. v. CCA with ipsilateral ICA occlusion. vi. ICA distal to CCA stenosis. vii. ICA <50% stenosis. viii. ICA 50-69% stenosis. ix. ICA >70% stenosis. x. CCA distal to innominate artery stenosis (right side) xi. CCA distal to proximal CCA stenosis.
c. Abnormal Carotid Waveforms Associated with Cardiac Disease. i. Intra-aortic balloon pump. ii. Left ventricular assist device. iii. Arrhythmia. iv. Aortic Valve Stenosis. v. Aortic valve insufficiency.
d. Normal Vertebral artery. e. Abnormal Vertebral Artery Flow: Subclavian Steal.
i. Vertebral artery pre-steal. ii. Vertebral artery partial steal. iii. Vertebral artery complete steal.
PSVM CONSENSUS 2019 Carotid Duplex Scan
Ma. Teresa Abola, MD, FPCP, FPCC, FPSVM Lilibeth Maravilla, MD, FPCP, FPCC, FPSVM Patricio Palmes, MD, FPCP, FPCC, FPSVM
Richie Limbungan, MD, FPCC, FPSVM
I. Summary of Criteria for Carotid Stenosis: ICA, NON-ICA and Vertebral artery.
*Disclaimer Note: Accept and validate criteria in your laboratory
DEGREE OF STENOSIS
PSV SECONDARY PARAMETERS (with borderline
PSV) MODERATE Internal Carotid Artery Stenosis
50-69% 140-230
cm/sec
EDV <110 cm/sec
ICA/CCA RATIO 2-3.9
Visible plaque estimate >50%
diameter reduction.
SEVERE Internal Carotid Artery Stenosis
³70% >230 cm/sec
EDV >110 cm/sec
ICA/CCA RATIO >4
Visible plaque estimate >50%
diameter reduction.
NON-ICA Stenosis: Common Carotid Artery, External Carotid Artery, Proximal Subclavian Artery
³50%
DOUBLING OR >100% increase in velocity (PSV)
PLUS 1. Post-stenostic
turbulence at site of plaque/stenosis.
2. Visible plaque estimate of >50% diameter reduction.
VERTEBRAL ARTERY Stenosis
³50% >100 cm/sec
Note for Vertebral artery: • Normal diameter: >3mm • Hypoplastic: <2mm • Normal PSV:
o Origin: 30-100 cm/sec o V1 to V2: 20-60 cm/sec
NON-SIGNIFICANT STENOSIS
Internal Carotid Artery <50% <140
cm/sec
Visible plaque estimate <50% diameter
reduction. NON-ICA (Common carotid artery and External carotid artery) <50%
<100% increase in velocity (PSV)
PLUS Visible plaque estimate
<50% diameter reduction.
PSVM CONSENSUS 2019 Carotid Duplex Scan
Ma. Teresa Abola, MD, FPCP, FPCC, FPSVM Lilibeth Maravilla, MD, FPCP, FPCC, FPSVM Patricio Palmes, MD, FPCP, FPCC, FPSVM
Richie Limbungan, MD, FPCC, FPSVM
IIa. Normal Cerebrovascular Waveforms.
PSVM CONSENSUS 2019 Carotid Duplex Scan
Ma. Teresa Abola, MD, FPCP, FPCC, FPSVM Lilibeth Maravilla, MD, FPCP, FPCC, FPSVM Patricio Palmes, MD, FPCP, FPCC, FPSVM
Richie Limbungan, MD, FPCC, FPSVM
IIb. Abnormal Cerebrovascular Waveforms.
PSVM CONSENSUS 2019 Carotid Duplex Scan
Ma. Teresa Abola, MD, FPCP, FPCC, FPSVM Lilibeth Maravilla, MD, FPCP, FPCC, FPSVM Patricio Palmes, MD, FPCP, FPCC, FPSVM
Richie Limbungan, MD, FPCC, FPSVM
IIc. Abnormal Carotid Waveforms Associated with Cardiac Disease.
PSVM CONSENSUS 2019 Carotid Duplex Scan
Ma. Teresa Abola, MD, FPCP, FPCC, FPSVM Lilibeth Maravilla, MD, FPCP, FPCC, FPSVM Patricio Palmes, MD, FPCP, FPCC, FPSVM
Richie Limbungan, MD, FPCC, FPSVM
IId. Normal Vertebral artery.
PSVM CONSENSUS 2019 Carotid Duplex Scan
Ma. Teresa Abola, MD, FPCP, FPCC, FPSVM Lilibeth Maravilla, MD, FPCP, FPCC, FPSVM Patricio Palmes, MD, FPCP, FPCC, FPSVM
Richie Limbungan, MD, FPCC, FPSVM
IIe. Abnormal Vertebral Artery Flow: Subclavian Steal. *Disclaimer Note: Above waveforms are not validated. Please accept and validate in your laboratory
