Transoral Carotid Ultrasonography Using A Micro Convex Probe with B-flow Imaging for Extracranial Internal Carotid Artery Dissection

• Published in: Journal of stroke and cerebrovascular diseases Vol. 21; no. 8; pp. 912.e5 - 912.e7
• Main Authors: Sakima, Hirokuni, MD, Isa, Katsunori, MD, PhD, Anegawa, Takahiro, MD, Kokuba, Kazuhito, MD, Nakachi, Koh, MD, Goya, Yoshino, MD, Tokashiki, Takashi, MD, PhD, Ishiuchi, Shogo, MD, PhD, Ohya, Yusuke, MD, PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2012
• Subjects: B-flow imaging; Cardiovascular; Carotid Artery, Internal, Dissection - complications; Carotid Artery, Internal, Dissection - diagnostic imaging; Carotid Artery, Internal, Dissection - therapy; Carotid Stenosis - complications; Carotid Stenosis - diagnostic imaging; Carotid Stenosis - therapy; Endovascular Procedures - instrumentation; Equipment Design; Humans; Infarction, Middle Cerebral Artery - diagnosis; Infarction, Middle Cerebral Artery - etiology; internal carotid artery dissection; Magnetic Resonance Angiography; Male; micro convex probe; Middle Aged; Neurology; Predictive Value of Tests; Stents; transoral carotid ultrasonography; Treatment Outcome; Ultrasonography, Doppler, Color - instrumentation; internal carotid artery dissection; transoral carotid ultrasonography; micro convex probe; B-flow imaging
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2011.12.005

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.