Can An Ultrasound Test Detect The Carotid Artery Blood Flow?

Posted on Sat, 1 Oct 2016

Question: How precisely does a carotid artery ultrasound or sonogram measure the flow of blood passing though the artery, and if a transplant will be needed?

Answered by Dr. Rishi (35 minutes later)

Brief Answer:
It is evaluated with a Color Doppler.

Detailed Answer:
Hi.
Thanks for your question.
A Carotid Artery is evaluated with a Color Doppler test which is like an Ultrasound but with Color flow visualisation and Power mode to measure velocity of blood flow. The Ultrasound mode sees whether there is any plaque leading to decrease in diameter of the artery. The flow velocity gets raised if there is any stenosis or obstructing lesion. The velocity measurements give an exact reading of degree of flow obstruction.
The treatment is not transplant but a Surgery called Carotid Endarterectomy or a Carotid stenting but only if the blockage is more than 50%at least.
Take care and do let me know if you have any other questions.
Dr Rishi New XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Veerisetty Shyamkumar

Follow up: Dr. Rishi (10 hours later)

Does this testing show if the artery is damaged so badly that a replacement artery will be, or could be required? Thank You Dr.

Answered by Dr. Rishi (5 hours later)

Brief Answer:
Replacement is usually not required.

Detailed Answer:
Hi,
Thanks for your reply.
Carotid artery almost never requires replacement unless it has been cut during some injury or is deeply involved in some tumor or growth around it. Atherosclerotic disease which is the commonest affliction of the Carotid artery causes plaques inside the artery which causes the artery to get narrowed in diameter and sometimes pieces of the plaque can break and go into the brain blood supply leading to minor strokes or paralytic attacks. This is the reason that the treatment is done and we do it by cleaning the artery surgically or putting stents inside the artery - not by replacement.
Doppler shows it pretty well but the investigation of choice would be a CT Angiogram to decide which treatment option to be taken. But a CT is done only once the Doppler is suggestive of some problem.
Take care and feel free to ask any queries.
Dr Rishi, New XXXXXXX XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rishi (2 hours later)

So if the doppler shows over 50% blockage, a cat scan would be done and it would show if the plaque had damaged the artery badly enough that a replacement would be neccesary?

Answered by Dr. Rishi (47 minutes later)

Brief Answer:
Replacement is not required. Treatment is done for stenosis more than 70%

Detailed Answer:
Hi,
As I told you earlier replacement is not the treatment.
Have you had any symptoms like fainting attacks or weakness in any of the limbs or speech problems?
If not then treatment not required.
Treatment in case of Carotid stenosis more than 70% only. If patient has symptoms then treatment is indicated if stenosis is more than 50%.
The treatment in either case is to surgically clear the obstruction or do Angioplasty with a stent.
Replacement is never required.
Do let me know if there are other queries.
Take care,
Dr Rishi.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rishi (1 hour later)

Dr XXXXXXX I apologize for my ignorance, just one more question should suffice for me, can radiation treatments in the carotid area cause the plaque build up enough to cause damage to the artery to the point that the cleaning out process you mentioned would not be an option? I thank you tremendously and give you a 5 star rating on your answers, Thanks!

Answered by Dr. Rishi (1 hour later)

Brief Answer:
That is definitely possible.

Detailed Answer:
Hi.
Thanks for the answer.
Radiation treatment to the neck can cause inflammation around the artery and in the artery wall. And if disease develops in such an artery then replacement would be an option. But operating in a post radiation area would be very difficult. It would be preferable to manage it with stenting perhaps.
If you could let me know details of the patient I could guide you better.
Take care and do let me know if any doubts persist.
Dr Rishi.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rishi (32 minutes later)

Dr XXXXXXX I had mini-strokes and primary care doctor did some type of sonogram and then a vascular surgeon went in while I was conscious to clean the artery but put in an artificial artery instead, said the artery was to badly damaged, the plaque buildup was caused by high cholesterol and trigyliceride levels for multiple years and previous radiation a couple decades earlier. But I was never told about or treated for the high bloodwork results, multiple doctors and my former Oncologist new about the high bloodwork results but ignored them. The artery became infected and I had a transplant from my leg put in its place and my large chest muscle was put over it. I had to have Hyperbolic Oxygen treatments for it to heal. I am trying to determine why the vascular surgeon did not prepare for the possible need for the transplant from the start. The Primary care doctor I have now is a smart, caring physician and as soon as he got my bloodwork back put me on meds for the high cholesterol and triglycerides but I at least two doctors prior didn't tell me about the high results or that there was a problem I could treat with meds and diet, thats another story. I have many problems but I have reason to be suspicious of the health care providers I have received treatment from in the past, it is way to complicated to get into here but I have been trying to keep my questions very precise to avoid getting you and others involved in any other way than just general medical questions.

Answered by Dr. Rishi (36 minutes later)

Brief Answer:
The treatment has been correct.

Detailed Answer:
Hi,
Thank you very much for your detailed account.
The treatment you have undergone is perfectly correct. This would have been the best course in case of a plaqued artery with damage due to radiation. Neck radiation leaves a lot of inflammation and fibrosis as I told you earlier and doing Surgery is a Herculean task. Even if your daring Vascular Surgeon did it the skin would not heal due to the past radiation so flap cover as given to you would be the correct way to go ahead.
As for the blood work, medicines can get the lipids down but cannot do anything to the plaques that have already been deposited.
If I was treating you I would probably have done a similar line of treatment.
I do not think you need to worry about anything or feel wronged in any way.
Do let me know if there are any concerns and all the best for full recovery,
Regards,
Dr Rishi.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rishi (28 minutes later)

Yes of course, Dr Nissen in Ohio is trying to develop a drug to remove plaque buildup, I do not know the state of his work. I beleive the plaque would not have built up so badly had I been treated for the high Cholesterol and Triglycerides, at one point my Triglycerides were 575 mg/dl and were well over 200 for years, yet my physician's failed to mention it. Thank You for your help. No more questions, sorry to take up our time.

Answered by Dr. Rishi (14 minutes later)

Brief Answer:
You are right. Hypertriglycridemia should have been treated.

Detailed Answer:
Hi,
Thank you.
Triglycerides should have been treated by the Physicians.
That is absolutely correct.
I hope things could have been avoided and I hope Dr nissen succeeds. This would be so very helpful to all of us.
Wish you good health.
Take care,
Dr Rishi.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar