CTA of the head may be useful in treatment planning for patients with an established diagnosis of hemodynamically significant asymptomatic carotid stenosis. Specifically, intracranial collateral characterization may be important when considering both the initial decision to treat and treatment involving proximal embolic protection strategies. CTA Neck With IV Contrast CTA of the neck is useful in the surveillance imaging of some patients with asymptomatic carotid stenosis owing to the anatomic assessment of stenosis. Specifically, CTA of the neck is helpful when multivessel cerebrovascular disease or very severe stenosis is present, which might result in artifactual over or underestimation of the degree of disease by carotid Doppler, respectively [113]. CTA of the neck is also useful for treatment planning [114]. However, CTA of the neck may also underestimate the degree of stenosis in the setting of tortuosity or calcifications similar in density to contrast media [80]. Conversely, CTA may overestimate stenosis in the setting of very severe Cerebrovascular Diseases-Stroke near occlusive stenosis [115]. Dual-energy CT may help limit the overestimation of stenosis in some instances [116]. CTV Head With IV Contrast There is no relevant literature to support the use of CTV of the head in the surveillance imaging of asymptomatic carotid stenosis. MRA Head Without and With IV Contrast There is no relevant literature to support the use of contrast-enhanced MRA of the head in the surveillance imaging of asymptomatic carotid stenosis. MRA Head Without IV Contrast There is no literature to support MRA of the head as in ongoing routine surveillance imaging of known asymptomatic carotid disease. MRA of the head may be useful in treatment planning for patients with an established diagnosis of asymptomatic carotid stenosis.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. CTA of the head may be useful in treatment planning for patients with an established diagnosis of hemodynamically significant asymptomatic carotid stenosis. Specifically, intracranial collateral characterization may be important when considering both the initial decision to treat and treatment involving proximal embolic protection strategies. CTA Neck With IV Contrast CTA of the neck is useful in the surveillance imaging of some patients with asymptomatic carotid stenosis owing to the anatomic assessment of stenosis. Specifically, CTA of the neck is helpful when multivessel cerebrovascular disease or very severe stenosis is present, which might result in artifactual over or underestimation of the degree of disease by carotid Doppler, respectively [113]. CTA of the neck is also useful for treatment planning [114]. However, CTA of the neck may also underestimate the degree of stenosis in the setting of tortuosity or calcifications similar in density to contrast media [80]. Conversely, CTA may overestimate stenosis in the setting of very severe Cerebrovascular Diseases-Stroke near occlusive stenosis [115]. Dual-energy CT may help limit the overestimation of stenosis in some instances [116]. CTV Head With IV Contrast There is no relevant literature to support the use of CTV of the head in the surveillance imaging of asymptomatic carotid stenosis. MRA Head Without and With IV Contrast There is no relevant literature to support the use of contrast-enhanced MRA of the head in the surveillance imaging of asymptomatic carotid stenosis. MRA Head Without IV Contrast There is no literature to support MRA of the head as in ongoing routine surveillance imaging of known asymptomatic carotid disease. MRA of the head may be useful in treatment planning for patients with an established diagnosis of asymptomatic carotid stenosis.