However, caution must be observed when evaluating patients with either extremely severe stenosis or multivessel involvement because Doppler can overestimate the degree of stenosis in the setting of contralateral disease or multivessel disease or underestimate the stenosis in the setting of critical high-grade stenosis, which may result in artifactual elevation of velocity or reduction in velocity, respectively. Clinically significant carotid disease may trigger further anatomic imaging to characterize stenosis and exclude confounding multivessel disease; however, there is no consensus on this matter. In otherwise uncomplicated cases, US imaging alone may be the only necessary examination in a patient with carotid bruit. US Duplex Doppler Transcranial Transcranial Doppler may be useful, both in the detection of microembolic events and in determining the hemodynamic significance of a known carotid stenosis. However, there is no literature to support transcranial Doppler in the initial workup of the asymptomatic patient with a carotid bruit. Variant 10: Adult. Asymptomatic carotid stenosis. Surveillance imaging. Asymptomatic carotid stenosis is an important diagnostic finding, which may progress to symptomatic stenosis. For asymptomatic patients, advances in medical therapy have rendered data from older clinical trials on the benefit of endarterectomy out of date, and thus the value of determining the degree of stenosis in these patients is less clear and currently the subject of a large randomized clinical trial [108-110]. Currently, guidelines from professional societies continue to recommend CEA for certain selected patients with asymptomatic stenosis in which the degree of stenosis is an important deciding factor [111,112]. Surveillance imaging is an important tool in the management Cerebrovascular Diseases-Stroke of asymptomatic carotid stenosis.
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. However, caution must be observed when evaluating patients with either extremely severe stenosis or multivessel involvement because Doppler can overestimate the degree of stenosis in the setting of contralateral disease or multivessel disease or underestimate the stenosis in the setting of critical high-grade stenosis, which may result in artifactual elevation of velocity or reduction in velocity, respectively. Clinically significant carotid disease may trigger further anatomic imaging to characterize stenosis and exclude confounding multivessel disease; however, there is no consensus on this matter. In otherwise uncomplicated cases, US imaging alone may be the only necessary examination in a patient with carotid bruit. US Duplex Doppler Transcranial Transcranial Doppler may be useful, both in the detection of microembolic events and in determining the hemodynamic significance of a known carotid stenosis. However, there is no literature to support transcranial Doppler in the initial workup of the asymptomatic patient with a carotid bruit. Variant 10: Adult. Asymptomatic carotid stenosis. Surveillance imaging. Asymptomatic carotid stenosis is an important diagnostic finding, which may progress to symptomatic stenosis. For asymptomatic patients, advances in medical therapy have rendered data from older clinical trials on the benefit of endarterectomy out of date, and thus the value of determining the degree of stenosis in these patients is less clear and currently the subject of a large randomized clinical trial [108-110]. Currently, guidelines from professional societies continue to recommend CEA for certain selected patients with asymptomatic stenosis in which the degree of stenosis is an important deciding factor [111,112]. Surveillance imaging is an important tool in the management Cerebrovascular Diseases-Stroke of asymptomatic carotid stenosis.