Noninvasive imaging of carotid arteries in stroke: emerging value of real-time high-resolution sonography in carotid occlusion due to cardiac embolism.
OBJECTIVE
Comprehension of the pathophysiologic characteristics of atherosclerosis has focused its attention on the study of dynamic and metabolic processes involving the vessel wall as possible causes of stroke. When compared with conventional radiologic techniques, sonography has the main advantage of being a real-time imaging modality. We report 2 acute stroke cases in which carotid sonography showed some dynamic features that could not be identified with computed tomography (CT) and magnetic resonance angiography (MRA).


METHODS
Carotid sonography with high-resolution probes (9-14 MHz) was compared with CT and MRA findings showing carotid axis occlusion in 2 patients with acute stroke.


RESULTS
In case 1, the internal carotid artery occlusion observed on CT and MRA was interpreted as a dissection on a clinical basis, but sonography showed a mobile embolus originating from the heart in the internal carotid artery. In case 2, the occlusion of the whole carotid axis observed on CT and MRA was instead related to a heart-originating embolus floating in the common carotid artery.


CONCLUSIONS
The evaluation of dynamic aspects of atherosclerosis is fundamental to understanding the pathophysiologic characteristics of stroke. Sonography is fundamental in carotid artery imaging for its possibility of showing dynamic processes that could be misdiagnosed with "static" imaging. The correct identification of the pathophysiologic characteristics of stroke in these cases could have led to different diagnostic and therapeutic algorithms.
Vicenzini
Edoardo
E
Department of Neurological Sciences, University of Rome La Sapienza, Viale dell'Università 30, Rome, Italy. edoardo.vicenzini@uniroma1.it
Giannoni
Maria Fabrizia
MF
Ricciardi
Maria Chiara
MC
Toscano
Massimiliano
M
Sirimarco
Gaia
G
Di Piero
Vittorio
V
Lenzi
Gian Luigi
GL
D000208:Acute Disease; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography