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(Circulation. 1999;100:e82-e83.)
© 1999 American Heart Association, Inc.

Circulation Electronic Pages

Ulceration and Stenosis of Internal Carotid Artery Imaged by Convergent Color Doppler

Katsufumi Mizushige, MD; Hideo Ohyama, MD; Masaya Kitadai, MD; Shoichi Senda, MD; Hirohide Matsuo, MD

From the Second Department of Internal Medicine, and Primary Care Medicine (S.S.), Kagawa Medical University, Japan.

Correspondence to Katsufumi Mizushige, MD, Second Department of Internal Medicine, Kagawa Medical University, 1750-1, Miki, Kita, Kagawa 761-0793, Japan. E-mail katsumz@kms.ac.jp

	Introduction

 
A65-year-old man was admitted to our hospital because of a transient cerebral ischemic attack. Cranial CT and MRI showed no specific abnormality. Carotid imaging was performed with a newly developed convergent color Doppler (CCD), which images information on both flow velocity and Doppler signal energy simultaneously. These correspond to frequency shift and integral of Doppler frequency-power spectrum, respectively. In CCD, because the flow including high-velocity component is colored, turbulent or vortex flow was clearly distinguished from laminar flow with physiological flow velocity. The CCD flow image revealed hollowing at the inner surface of the carotid wall, depicted as blue area (arrow). This was considered as reflecting a vortex flow at the site of ulcer lesion. An accelerated poststenotic flow was demonstrated as a red area (Figure, top). Two-dimensional echo could depict a clear stenotic lesion but no definite ulceration. Carotid artery angiography confirmed the ulceration and stenosis at the same site (Figure, lower left) despite no observation of the lesion on MR angiography. On the basis of the CCD information, endarterectomy was performed, and the ulcer lesion with a small thrombus was confirmed pathomorphologically (Figure, lower right). It is likely that a microthrombus formed in this ulceration, causing a transient ischemic attack.

View larger version (89K): [in this window] [in a new window]   Figure 1. CCD carotid image (top), carotid artery angiogram (lower left), and pathological sample of lesion obtained by endarterectomy (lower right). CCD revealed flow image hollowing at inner surface of carotid wall, depicted as blue area (arrow). An accelerated poststenotic flow was imaged as red . . . [Full Text of this Article]