Carotid ultrasound is a non-invasive diagnostic procedure in which high-frequency sound waves are used to create images of the arteries in the neck. These arteries provide blood to the brain, neck and face and hence have very important role in cardiovascular and neurological systems. The test uses ultrasonic waves to capture structural images of the carotid arteries that are located at two levels at the lateral sides of the neck.
Carotid ultrasound
Indications
Preventive Assessment and Assessment of Atherosclerosis:
Asymptomatic Patients at High Risk: Screenings may be done in patients with antecedent risk factors like hypertension, hyperglycemia, smoking, hyperlipidemia or a family history of atherosclerotic disease.
Symptomatic Patients: Patients having clinical signs of cerebrovascular disease like TIA or minor ischemic stroke may need carotid stenosis ultrasound.
Assessment of Previously Detected Carotid Artery Disease: In cases where patients with carotid stenosis or atherosclerotic plaque are known, carotid ultrasound is performed to review the disease progression or evaluate the effectiveness of therapies or interventions.
Preoperative Assessment:
Cardiac or Major Vascular Surgery: It may also be performed preoperatively in patients with risk factors for carotid artery disease to determine the risk of postoperative stroke.
Post-Intervention
Follow-Up After carotid endarterectomy or stenting: Carotid interventions may result in restenosis or other complications, and the patient may need come for follow up ultrasound evaluations.
Neurological Symptoms Suggestive of Carotid Artery Disease:
Neurological symptoms frequently associated with carotid artery disease symptoms like, weakness or numbness in an arm and facial droop or inability to speak clearly, blurred vision or sudden trouble seeing, dizziness, these may point towards a TIA or stroke and the carotid ultrasound can help identify if this stenosis is the reason.
Bruit Detection:
Presence of a Carotid Bruit: An abnormal sound (bruit) found when stethoscope is placed on carotid artery during an auscultation can indicate turbulent blood flow, usually caused by the build-up or narrowing.
A carotid ultrasound can determine the cause and the extent of this condition. In this case in children with inflammatory or other systemic conditions.
Assessment in Inflammatory or Other Systemic Conditions:
Sometimes specific diseases such as Takayasu arteritis or giant cell arteritis can involve the carotid arteries and ultrasound is valuable.
Contraindications
Severe neck injuries or trauma:
In cases where a patient has had a neck injury within the last few weeks or has suffered significant trauma their neck may be too tender, swollen, or risky to form optimal images.
Severe respiratory distress:
Patients with breathing complaints may not find it easy to lie down flat for the procedure.
Inability to lie still or cooperate:
Conditions that cause tremor, severe pain, or cognitive impairment may make it challenging to obtain accurate images.
Neck masses or recent surgery in the neck area:
Some conditions such as previous scars, masses or post-surgical change in the neck make it difficult to perform the ultrasound or interpret the findings because of distorted anatomical structures.
Excessive obesity or very thick neck tissues:
In some instances, it might be a disadvantage that soft tissues distort the image, however, this is mostly an issue easily controllable through experience and proper use of equipment by most technicians.
Medical History Review: The technologist or provider may inquire into the patient’s cardiovascular past and presence of stroke, TIA, hypertension, smoking, or high cholesterol.
Symptom Review: Remember any neurological signs that may have developed in the last week such as dizziness, loss of vision or feeling of numbness since they may be related to carotid artery diseases.
Allergies: The test is painless and non-invasive, but it is important to ask for allergies or skin sensitivity to any reactions to the gel used when taking the test.
Patient position:
Supine Position: The patient will be asked to lie on the back on the examination table on the back, face up. The head may be bent a little backward and to the side opposite to the neck that needs to be flattened.
Pillow or Neck Support: A pillow may be placed under the neck or shoulders to allow the neck to be extended for imaging of the region and to also make the patient comfortable during the study.
Technique
Step 1: Patient Preparation:
Explain the procedure to the patient to alleviate any anxiety.
Analyze the patient outcomes and tell the patient to lie straight against the examination table on the back (supine position).
Step 2: Equipment Setup: Make sure the ultrasound machine is ready for use with the type of transducer that is most often a high-frequency linear transducer.
When treating the neck tissues of a patient, the physiotherapist should change settings of gain, depth, and frequency accordingly.
Step 3: Performing the Ultrasound:
Patient Positioning: Move a pillow slightly up from under the patient’s shoulders to produce cervical flexion and have the carotid arteries more prominent.
Bend the patient’s head to the opposite side of where the assessment is to be made (approx. 45 degrees).
Applying Gel: Place a substantial amount of ultrasound gel on the patient’s neck on the site of the carotid arteries. This gel assists in passing the sound waves and improves the image quality.
Initial Scanning:
Start by locating the common carotid artery (CCA) typically found lateral to the thyroid gland.
Draw the CCA with a linear transducer both in cross-sectional and longitudinal view.
Imaging the Carotid Arteries:
Transverse View: Place the transducer in the transverse (horizontal) plane in the neck for visualizing CCA, ECA (External carotid artery), and ICA (Internal carotid artery).
Evaluating the diameter, the wall thickness, and plaques or stenosis.
Longitudinal View: To create a longitudinal view of the CCA and ICA, rotate the transducer.
Examine the vessels for pathologic characteristics, for example, plaques, the narrowing of the lumen, or other pathologic vascular alteration.
Doppler Assessment: As an example, use the Doppler feature for evaluating the flow of blood.
Position the Doppler sample volume appropriately to get the velocities, especially in internal carotid and external carotid arteries.
Measures maximal systolic velocity and end-diastolic velocity in case of identifying stenosis.
Additional Views: Perform vertebral and or subclavian arterial studies in cases that are warranted. Get images at any required level from the carotid bifurcation down to the distal subclavian.
Final Steps Documentation: Print all the images and Doppler waveforms obtained from the study. Also record details such as stenosis, plaque characteristics, and velocities of blood flow.
Cleaning Up:
Wipe off any excess gel gently.
Clean the transducer with appropriate disinfectant according to facility protocols.
Step 4: Post-Procedure: Inform the patient of any post-procedure instructions as may be required. Let the patient know when they should expect a call about the results or when they should call for the results.
4.Complications
Skin Irritation: The gel applied to the skin during the ultrasound sometimes may provoke mild skin itching or rash, though this condition is rather rare.
Discomfort: Where the ultrasound probe is used, mild discomfort or pressure is usually felt, and this may be due to increased pressure in the case the sonographer applies pressure to have a better image.
Syncope (Fainting): Certain patients may feel dizzy or faint which is common with patients who are easily bothered or already have a history of developing vasovagal syncope during tests. This is very rare and sometimes controlled actively through the medical team.
Nerve Irritation: The carotid sinus near the bifurcation of the carotid artery can be sensitive to pressure. Torsion in this area could theoretically cause bradycardia, or slowing of heart rate, or even temporary unconsciousness. This is rare with carotid ultrasound because sonographers are taught not to apply excessive pressure.
Allergic Reactions: Some ultrasound gels come with some ingredients that are harmful to people with skin allergies although this problem is rare. The side effects can be mild, such as redness, itching in the area where the product was applied, or in extreme cases anaphylaxis.
Uneasiness or Disturbance Concerning the Procedure: For various reasons, some people may feel uncomfortable during the procedure due to some procedures such as first-time ultrasound and others feel uncomfortable when technician examines them around the neck area.
Carotid ultrasound is a non-invasive diagnostic procedure in which high-frequency sound waves are used to create images of the arteries in the neck. These arteries provide blood to the brain, neck and face and hence have very important role in cardiovascular and neurological systems. The test uses ultrasonic waves to capture structural images of the carotid arteries that are located at two levels at the lateral sides of the neck.
Carotid ultrasound
Preventive Assessment and Assessment of Atherosclerosis:
Asymptomatic Patients at High Risk: Screenings may be done in patients with antecedent risk factors like hypertension, hyperglycemia, smoking, hyperlipidemia or a family history of atherosclerotic disease.
Symptomatic Patients: Patients having clinical signs of cerebrovascular disease like TIA or minor ischemic stroke may need carotid stenosis ultrasound.
Assessment of Previously Detected Carotid Artery Disease: In cases where patients with carotid stenosis or atherosclerotic plaque are known, carotid ultrasound is performed to review the disease progression or evaluate the effectiveness of therapies or interventions.
Preoperative Assessment:
Cardiac or Major Vascular Surgery: It may also be performed preoperatively in patients with risk factors for carotid artery disease to determine the risk of postoperative stroke.
Post-Intervention
Follow-Up After carotid endarterectomy or stenting: Carotid interventions may result in restenosis or other complications, and the patient may need come for follow up ultrasound evaluations.
Neurological Symptoms Suggestive of Carotid Artery Disease:
Neurological symptoms frequently associated with carotid artery disease symptoms like, weakness or numbness in an arm and facial droop or inability to speak clearly, blurred vision or sudden trouble seeing, dizziness, these may point towards a TIA or stroke and the carotid ultrasound can help identify if this stenosis is the reason.
Bruit Detection:
Presence of a Carotid Bruit: An abnormal sound (bruit) found when stethoscope is placed on carotid artery during an auscultation can indicate turbulent blood flow, usually caused by the build-up or narrowing.
A carotid ultrasound can determine the cause and the extent of this condition. In this case in children with inflammatory or other systemic conditions.
Assessment in Inflammatory or Other Systemic Conditions:
Sometimes specific diseases such as Takayasu arteritis or giant cell arteritis can involve the carotid arteries and ultrasound is valuable.
Severe neck injuries or trauma:
In cases where a patient has had a neck injury within the last few weeks or has suffered significant trauma their neck may be too tender, swollen, or risky to form optimal images.
Severe respiratory distress:
Patients with breathing complaints may not find it easy to lie down flat for the procedure.
Inability to lie still or cooperate:
Conditions that cause tremor, severe pain, or cognitive impairment may make it challenging to obtain accurate images.
Neck masses or recent surgery in the neck area:
Some conditions such as previous scars, masses or post-surgical change in the neck make it difficult to perform the ultrasound or interpret the findings because of distorted anatomical structures.
Excessive obesity or very thick neck tissues:
In some instances, it might be a disadvantage that soft tissues distort the image, however, this is mostly an issue easily controllable through experience and proper use of equipment by most technicians.
Medical History Review: The technologist or provider may inquire into the patient’s cardiovascular past and presence of stroke, TIA, hypertension, smoking, or high cholesterol.
Symptom Review: Remember any neurological signs that may have developed in the last week such as dizziness, loss of vision or feeling of numbness since they may be related to carotid artery diseases.
Allergies: The test is painless and non-invasive, but it is important to ask for allergies or skin sensitivity to any reactions to the gel used when taking the test.
Patient position:
Supine Position: The patient will be asked to lie on the back on the examination table on the back, face up. The head may be bent a little backward and to the side opposite to the neck that needs to be flattened.
Pillow or Neck Support: A pillow may be placed under the neck or shoulders to allow the neck to be extended for imaging of the region and to also make the patient comfortable during the study.
Step 1: Patient Preparation:
Explain the procedure to the patient to alleviate any anxiety.
Analyze the patient outcomes and tell the patient to lie straight against the examination table on the back (supine position).
Step 2: Equipment Setup: Make sure the ultrasound machine is ready for use with the type of transducer that is most often a high-frequency linear transducer.
When treating the neck tissues of a patient, the physiotherapist should change settings of gain, depth, and frequency accordingly.
Step 3: Performing the Ultrasound:
Patient Positioning: Move a pillow slightly up from under the patient’s shoulders to produce cervical flexion and have the carotid arteries more prominent.
Bend the patient’s head to the opposite side of where the assessment is to be made (approx. 45 degrees).
Applying Gel: Place a substantial amount of ultrasound gel on the patient’s neck on the site of the carotid arteries. This gel assists in passing the sound waves and improves the image quality.
Initial Scanning:
Start by locating the common carotid artery (CCA) typically found lateral to the thyroid gland.
Draw the CCA with a linear transducer both in cross-sectional and longitudinal view.
Imaging the Carotid Arteries:
Transverse View: Place the transducer in the transverse (horizontal) plane in the neck for visualizing CCA, ECA (External carotid artery), and ICA (Internal carotid artery).
Evaluating the diameter, the wall thickness, and plaques or stenosis.
Longitudinal View: To create a longitudinal view of the CCA and ICA, rotate the transducer.
Examine the vessels for pathologic characteristics, for example, plaques, the narrowing of the lumen, or other pathologic vascular alteration.
Doppler Assessment: As an example, use the Doppler feature for evaluating the flow of blood.
Position the Doppler sample volume appropriately to get the velocities, especially in internal carotid and external carotid arteries.
Measures maximal systolic velocity and end-diastolic velocity in case of identifying stenosis.
Additional Views: Perform vertebral and or subclavian arterial studies in cases that are warranted. Get images at any required level from the carotid bifurcation down to the distal subclavian.
Final Steps Documentation: Print all the images and Doppler waveforms obtained from the study. Also record details such as stenosis, plaque characteristics, and velocities of blood flow.
Cleaning Up:
Wipe off any excess gel gently.
Clean the transducer with appropriate disinfectant according to facility protocols.
Step 4: Post-Procedure: Inform the patient of any post-procedure instructions as may be required. Let the patient know when they should expect a call about the results or when they should call for the results.
4.Complications
Skin Irritation: The gel applied to the skin during the ultrasound sometimes may provoke mild skin itching or rash, though this condition is rather rare.
Discomfort: Where the ultrasound probe is used, mild discomfort or pressure is usually felt, and this may be due to increased pressure in the case the sonographer applies pressure to have a better image.
Syncope (Fainting): Certain patients may feel dizzy or faint which is common with patients who are easily bothered or already have a history of developing vasovagal syncope during tests. This is very rare and sometimes controlled actively through the medical team.
Nerve Irritation: The carotid sinus near the bifurcation of the carotid artery can be sensitive to pressure. Torsion in this area could theoretically cause bradycardia, or slowing of heart rate, or even temporary unconsciousness. This is rare with carotid ultrasound because sonographers are taught not to apply excessive pressure.
Allergic Reactions: Some ultrasound gels come with some ingredients that are harmful to people with skin allergies although this problem is rare. The side effects can be mild, such as redness, itching in the area where the product was applied, or in extreme cases anaphylaxis.
Uneasiness or Disturbance Concerning the Procedure: For various reasons, some people may feel uncomfortable during the procedure due to some procedures such as first-time ultrasound and others feel uncomfortable when technician examines them around the neck area.
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