title: Transoral carotid ultrasonography using a micro convex probe with B-flow imaging for extracranial internal carotid artery dissection.
abstract: We report on transoral carotid ultrasonography using a micro convex probe with B-flow imaging for determining spontaneous extracranial internal carotid artery dissection just below the petrous portion. A 49-year-old man suffered cortical and subcortical infarction in the region of the right middle cerebral artery. Magnetic resonance angiography on the third day of admission revealed spontaneous recanalization of the right internal carotid artery associated with an intimal flap-like structure at the petrous portion. Transoral carotid ultrasonography using a micro convex probe revealed right extracranial internal carotid artery dissection, showing an increased diameter of the right extracranial internal carotid artery with double lumen formation, stenosis of the true lumen, and a mobile intimal flap in B-flow imaging. Transoral carotid ultrasonography using a micro convex probe was helpful to attempt a self-expanding stent for recanalizing right extracranial internal carotid artery dissection. The patient recovered and was discharged ambulatory. The size of the micro convex probe was optimum for transoral carotid ultrasonography in our patient. Micro convex probe is more commonly used than the standard transoral carotid ultrasonography probe, which lacks versatility. We consider that transoral carotid ultrasonography using a micro convex probe could be routinely used for ultrasonographic evaluation of extracranial internal carotid artery dissection.
authors.affiliation: Department of Cardiovascular Medicine, Nephrology and Neurology, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan. sakima51@gmail.com
authors.forename: Hirokuni
authors.initials: H
authors.lastname: Sakima
authors.forename: Katsunori
authors.initials: K
authors.lastname: Isa
authors.forename: Takahiro
authors.initials: T
authors.lastname: Anegawa
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Kokuba
authors.forename: Koh
authors.initials: K
authors.lastname: Nakachi
authors.forename: Yoshino
authors.initials: Y
authors.lastname: Goya
authors.forename: Takashi
authors.initials: T
authors.lastname: Tokashiki
authors.forename: Shogo
authors.initials: S
authors.lastname: Ishiuchi
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Ohya
mesh_terms: D020215:Carotid Artery, Internal, Dissection / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D057510:Endovascular Procedures / Q000295:instrumentation; D004867:Equipment Design; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000175:diagnosis / Q000209:etiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015607:Stents; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation*