VT Carotid & Vertebral Ultrasound 2

Question 1

What PSV ratio (ICA/CCA) is used to classify a 70-99% ICA stenosis per the SRU consensus criteria?

Accepted Answer

Greater than 4.0

Answer

An ICA/CCA PSV ratio greater than 4.0 is used along with PSV >230 cm/s to classify 70-99% ICA stenosis by SRU consensus criteria.

Question 2

In vertebral artery assessment, which waveform pattern indicates subclavian steal syndrome?

Accepted Answer

Alternating or fully reversed flow direction

Answer

Subclavian steal syndrome produces alternating (partial steal) or fully reversed (complete steal) vertebral artery flow due to proximal subclavian artery stenosis/occlusion.

Question 3

Which vessel is the most common site for fibromuscular dysplasia (FMD) in the extracranial carotid system?

Accepted Answer

Mid-to-distal internal carotid artery

Answer

FMD most commonly affects the mid-to-distal ICA, producing a classic 'string of beads' appearance on imaging.

Question 4

A patient has no detectable ICA flow on duplex. What finding would suggest occlusion rather than a technically difficult exam?

Accepted Answer

High-resistance CCA waveform with absent diastolic flow

Answer

ICA occlusion causes the ipsilateral CCA to develop a high-resistance, low-diastolic waveform because the high-resistance ECA becomes the dominant outflow.

Question 5

What is the normal peak systolic velocity range for the common carotid artery in adults?

Accepted Answer

60-100 cm/s

Answer

Normal CCA PSV is typically 60-100 cm/s; values above this threshold (especially >125 cm/s) may indicate proximal or tandem disease.

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VT Carotid & Vertebral Ultrasound 2