VIDEO
(Doctors only)
Carotid ultrasound (CUS)
. To assess for internal carotid artery stenosis or occlusion.
. Shows you direction of vertebral artery flow.
. You might not need it if you have a good-quality normal MRA or CTA of the extracranial circulation.
CUS can be used to confirm a stenosis seen on MRA or CTA. If these non-invasive tests are concordant, it may not be necessary to do an invasive DSA to determine candidacy for endovascular or surgical treatment of a carotid stenosis.
Transcranial Doppler (with or without bubble study).
To monitor clot presence and lysis in the acute setting.
To confirm intracranial stenosis/occlusion of major arteries seen on MRA or CTA.
. Emboli detection/monitoring.
. Look for PFO by injecting microbubbles.
TCD with ‘‘bubble study’’ is the most sensitive and least expensive/invasive way to screen for right to left shunting.
. Hemodynamic reserve (breath holding index, vasomotor reactivity).
. Evaluate collateral flow patterns.
Digital subtraction angiography (DSA)
. Gold standard for determining degree of stenosis.
. Only way to definitively delineate and follow aneurysms or AVMs, dissection, vasculitis, or other arteriopathies. Fasting lipids . Look for high total cholesterol, triglycerides, LDL (target LDL <100mg/dL; for very high-risk patients LDL <70 mg/dL).
. Look for low HDL. Hemoglobin A1c (HbA1c)
. Screen for diabetes and its recent control.
