Ultrasound Techniques in the Study of Carotid Artery Atheroma

  • Robert J. Lusby
Conference paper
Part of the NATO Advanced Study Institutes Series book series (NSSA, volume 51)


Cerebrovascular disease is the third most frequent cause of death in western society. In Europe over one million new cases of stroke are reported each year, with a 30 percent mortality and a 60 percent incidence of substantial disability among the survivors. In 19T3 it was estimated that over 7 billion dollars was spent annually in the initial hospital care of these patients (1,2). It is generally estimated that 60–70 percent of strokes are due to thromboembolism (3,4). The importance of extracranial atherosclerotic disease in the production of stroke has been recognised only in the last 30 years (5,6). Recent studies have shown up to 88% of patients with cerebral ischaemia to have extracranial artery lesions (7,8) with the majority situated at the carotid artery bifurcation (9). There are two basic mechanisms by which carotid artery lesions produce cerebral ischaemia (A) reduced flow from a high grade stenosis or occlusion and (B) from emboli generated from the region of atheromatous plaques.


Carotid Artery Internal Carotid Artery Transient Ischaemic Attack Atheromatous Plaque Ultrasound Technique 
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  1. 1.
    Haberman, S., Capildeo, R., and Clifford Rose, F., Epidemiolo-gical aspects of stroke, In: Progress in Stroke Research 1, R. Greenhalgh and F. Clifford Rose, eds., Pitman Medical, pp. 3–l4 (1979).Google Scholar
  2. 2.
    Jürgen, M., World Health Organization Stroke Register, Medical Tribune (1973).Google Scholar
  3. 3.
    Kannel, W.B., Wolf, P.A., Verter, J., Epidemiologic assessment of the role of blood pressure and stroke — The Framingham Study, J.A.M.A. 2l4: 301–310 (1970).Google Scholar
  4. 4.
    Whisnant, J.P., Matsumoto, N., and Elvebeck L.R., Transient cerebral ischaemic attacks in a community, Mayo Clin.Proc. kB: 194–198 (1973).Google Scholar
  5. 5.
    Fisher, M., Occlusion of the internal carotid artery, Arch. Neurol. Psychiat. 72: 182–204. (1951).Google Scholar
  6. 6.
    Yates, P.O., and Hutchinson, E.C. Cerebral infarction. The role of stenosis of the extracranial cerebral arteries. In: Medical Research Council Special Report Series No. 300, HMSO, London (1961).Google Scholar
  7. 7.
    Hutchinson, Acheson, Strokes: Natural History, Pathology and Surgical Treatment, W.B. Saunders, London (1975).Google Scholar
  8. 8.
    Eisenberg, R.L., Nemsek, W.R., Moore, W.S., andMani, R.L., Relationship of transient ischaemic attacks and angiographically demonstrable lesions of carotid artery, Stroke 8: 483 (1977).PubMedCrossRefGoogle Scholar
  9. 9.
    Hass, W.K., Fields W.S., North, R.R., Kricheff, I.I., Chase, N.E., and Bauer, B.B., Joint study of extracranial arterial occlusion: (l) Arteriography, techniques, sites and complications, J.A.M.A. 203: 961–968 (1968).PubMedCrossRefGoogle Scholar
  10. 10.
    Woodcock, J.P., King, D.H., Gosling, R.G., and Nueman, D.L., Physical aspects of the measurement of blood velocity by Doppler shifted ultrasound, In.: Blood Flow Measurement, C. Roberts, ed., Chapter 1, Sector Publ., London (1972).Google Scholar
  11. 11.
    Blackshear, W.M., Phillips, D.J., Thiele, B.L., Birsch, J.H., Chikos, P.M., Marinelli, M.R., Ward, K.J., and Strandness D.E., Detection of carotid occlusive disease by ultrasonic imaging and pulsed Doppler spectral analysis, Surgery 86: 698–707 (1979).PubMedGoogle Scholar
  12. 12.
    Baird, R.N., Bird, D.R., Clifford, P.C., Lusby, R.J., Skidmore, R., and Woodcock, U.P., Upstread stenosis: Its diagnosis by Doppler signals from the femoral artery, Arch.Surg. 115: 1316–1322 (1980).PubMedCrossRefGoogle Scholar
  13. 13.
    Fish, P.J. In: Blood Flow Measurement, V.S. Roberts, ed., Sector Publ. p. 29 (1972).Google Scholar
  14. 14.
    Mozersky, D.J., Bauer, D.W., Hokanson, D.E., Sumner, D.S., and Strandness, D.E., Ultrasonic arteriography, Arch.Surg. 103: 663–667 (1971).PubMedCrossRefGoogle Scholar
  15. 15.
    Barnes, R.W., Bone, G.E., Reinerston, J.E., Slaymaker, E.E., Hokanson, D.E., and Strandness, D.E. Jr., Noninvasive ultrasonic carotid angiography. Prospective validation by contrast arteriography, Surgery 80: 328 (1976).PubMedGoogle Scholar
  16. 16.
    Baird, R.N., Lusby, R.J., Bird D.R., Giddings, A.E.B., Skidmore, R., Woodcock, U.P., Horton, R.E., and Peacock, J.H., Pulsed Doppler angbiography in lower limb ischaemia, Surgery 80: 818–825 (1979).Google Scholar
  17. 17.
    Lusby, R.J., Pulsed Doppler assessment of the profunda femoris artery, In: Diagnosis and Monitoring in Arterial Surgery, R.N. Baird and J.P. Woodcock, eds., John Wright & Sons, Bristol (1980).Google Scholar
  18. 18.
    Sumner, D.S., Russell, J.B., Ramsey, D.E., Hajjar, W.M., and Miles, R.D., Noninvasive diagnosis of extracranial carotid arterial disease: A prospective evaluation of pulsed Doppler imaging and oculoplethysmography, Arch.Surg. Ilk: 1222–1229 (1979).Google Scholar
  19. 19.
    Lusby, R.J., Clifford, P.C., Bird, D.R., Skidmore, R., Woodcock, J.P., and Baird, R.N., Ultrasonic techniques in the study of graft survival, In: Haemodynamics of the limbs (ll) P. PueL, ed., (in press).Google Scholar
  20. 20.
    Lusby, R.J., Woodcock, J., Skidmore, R., Jeans, W., Clifford, P.C., and Baird, R.N., Carotid artery disease: A prospective evaluation of ultrasonic imaging in the detection of low and high grade stenosis, Br.J.Surg. 67: 823 (1980).Google Scholar
  21. 21.
    Lusby, R.J., Woodcock, J.P., Skidmore, R., Jeans, W.D., Hope, D.T., and Baird, R.N., Carotid artery disease: A prospective evaluation of pulsed Doppler imaging ultrasound, Med. Biol, (in press).Google Scholar
  22. 22.
    Lusby, R.J., Machleder, H.I., Jeans, W., Skidmore, R., Woodcock, J.P., Clifford, P.C., and Baird, R.N., Characterisation of vessel wall and blood flow dynamics in arterial thromboembolism, Proc.Roy. Soc. (in press).Google Scholar
  23. 23.
    Strandness, D.E., Jr., Schultz, R.O., Sumner, D.S., Rushmer, R.F., Ultrasonic flow detection: A useful technique in the evaluation of peripheral vascular disease, Am.J.Surg. 113: 311–320 (1967).PubMedCrossRefGoogle Scholar
  24. 24.
    McDonald, D.A., Blood Flow in Arteries ( 2nd ed. ), Edward Arnold, London, and Williams and Wilkins, Baltimore (1974).Google Scholar
  25. 25.
    Gersten, J.W., Relation of ultrasound effects to orientation of tendon in ultrasound field, Arch. Phys.Med.Rehabil. 37: 201 (1956).Google Scholar
  26. 26.
    Boughner, D.R., and Roach, M.R., Effect of low frequency vibration on arterial wall, Circ.Res. 29: 136 (l97l).Google Scholar
  27. 27.
    Greenfield, J.C., Tindall, G.T., Dillon, M.L., and Mahaley, M.S., Mechanics of the human carotid artery in vivo, Circ.Res. 15: 240 (1964).PubMedGoogle Scholar
  28. 28.
    Arndt, J.O., Klauske, J., and Mersch, F., The diameter of the intact carotid artery in man and its change with pulse pressure, Pfluegers Arch. 301: 230 (1968),Google Scholar
  29. 29.
    Heath, D., Smith, P., Harris, P., and Winson, M., The atherosclerotic human carotid sinus, J.Path. 110: 49–58 (1973).PubMedCrossRefGoogle Scholar
  30. 30.
    Gonza, E.R., Mason, W.F., Marble, A.E., Winter, D.A., and Dolan, F.G., Necessity for elastic properties in synthetic arterial grafts, Can.J.Surg. 17: 1–5 (1974).Google Scholar
  31. 31.
    Eiken, O. Pressure-flow relationship and thrombotic occlusion of experimental grafts, Acta Chir.Scand. 121: 398 (1961).PubMedGoogle Scholar
  32. 32.
    Baird, R.N., and Abbott, W.M., Pulsatile blood flow in arterial grafts, Lancet ii: 948–950 (1976).Google Scholar
  33. 33.
    Mustard, J.F., Murphy, E.A., Rowsell, H.C., and Downie, H.G., Factors influencing thrombus formation in vivo, Am.J.Med. 33: 621–646 (1962).PubMedCrossRefGoogle Scholar
  34. 34.
    Born, G.V.R., Arterial thrombosis and its prevention, S. Hayase and S. Murao, Proc. VIII World Congress of Cardiology, Tokyo, Excerpta Medica, Amsterdam (1978).Google Scholar
  35. 35.
    Machleder, H.I., Strokes, transient ischaemic attacks and asymptomatic bruits, West.J.Med. 130: 205–217 (1979).PubMedGoogle Scholar
  36. 36.
    Fry, D.L., Acute vascular endothelial changes associated with increased velocity gradients, Circ. Res. 22: 165 (1968).PubMedGoogle Scholar

Copyright information

© Plenum Press, New York 1982

Authors and Affiliations

  • Robert J. Lusby
    • 1
    • 2
  1. 1.University Dept. SurgeryBristol Royal InfirmaryBristolEngland
  2. 2.St. Vincent’s HospitalSydneyAustralia

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