Suzie El Saden MD, PRESENTER: Nothing to Disclose

Abstract: HTML Purpose: To explain the characteristic sonographic waveform abnormalities seen with innominate artery disease versus subclavian steal syndrome. Methods and Materials: A retrospective review of all cerebrovascular sonograms at our collective institutions in the past 5 years yielded 12 patients, 8 males, 4 females (mean age = 57.6) with spectral Doppler abnormalities in the right vertebral and right carotid arteries suspicious for innominate artery stenosis or occlusion. All had correlative angiography or Magnetic Resonance (MR) angiography Results: Four patients were asymptomatic and 8, symptomatic: right amaurosis fugax (2), syncope (3), subclavian steal syndrome (1) and right hemispheric stroke (2). 9 patients had reversed flow in the right vertebral artery, 3 had partial steal (antegrade flow in systole, retrograde in diastole) that converted to complete steal with maneuvers. One had steal in the right carotid system; the other 11 had varying degrees of mid-systolic deceleration in the right carotid arteries. Waveform abnormalities were typically found in the CCA and ICA, but seldom in the ECA. Tardus parvus waveforms were not found in any patient. Peak systolic velocity (PSV) in the CCA was lower on the right with an average ratio, left to right, of 3.4 (range of 1.7 to 5.7). On correlative imaging, all 12 patients had innominate artery disease ranging from 50% to occlusion. There was no correlation between Doppler findings and severity of stenosis. Conclusion: Distinctive alterations can be found in the sonographic waveforms of the right vertebral and carotid arteries in patients with severe innominate artery disease. These should be recognized and conveyed to those performing subsequent imaging, so that disease proximal to the carotid bifurcation will specifically be sought or this important abnormality may go undiagnosed.       Questions about this event email: edgrant@usc.edu

El Saden MD, S, Innominate Artery Occlusive Disease: Sonographic Findings.  Radiological Society of North America 2003 Scientific Assembly and Annual Meeting, November 30 - December 5, 2003 ,Chicago IL. http://archive.rsna.org/2003/3101656.html