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Color Duplex Scanning of Vertebral Artery

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Noninvasive Vascular Diagnosis

Abstract

An ultrasound examination of the extracranial portions of the vertebral artery constitutes an inexpensive and widely available screening method (being a mandatory part of a carotid duplex examination) to diagnose atherosclerotic disease and a variety of other findings and to further identify candidates for more invasive diagnostic evaluations. Furthermore, duplex scanning of the vertebral artery can help determine the pathogenic mechanism of an ischemic stroke and can lead to an early initiation of a mechanism-specific stroke treatment or prevention. Extracranial vertebral duplex scanning should be performed in conjunction with transcranial Doppler or color-coded duplex scanning in patients with stroke and transient ischemic attacks. The aim of this chapter is to describe the methods of vertebral artery color duplex scanning, practical criteria for interpretation, and relevance of these findings to patient management.

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Acknowledgments

Dr. Marc Ribo was the original first author of this chapter in the second edition of the book. Subsequent editions were modified from the second edition of the book.

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Authors and Affiliations

  1. Department of Neurology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Fetscherstr. 74, Dresden, Saxony, Germany

    Jessica Barlinn MD, MSc

  2. Department of Neurology, The University of Tennessee Health Science Center, 847 Monroe Avenue, Suite 226, Memphis, TN, 38163, USA

    Kristian Barlinn MD, MSc & Andrei V. Alexandrov MD

Authors
  1. Jessica Barlinn MD, MSc
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  2. Kristian Barlinn MD, MSc
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  3. Andrei V. Alexandrov MD
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Corresponding author

Correspondence to Andrei V. Alexandrov MD .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    TCD/TCCD allows assessment of the:

    1. a.

      The mid-cervical VA (V2)

    2. b.

      The proximal VA and its origin (V0/V1)

    3. c.

      The cerebral portion of the VA (V4)

    4. d.

      The most distal extracranial VA (V3)

  2. 2.

    A significant stenosis (≥50%) of the mid-cervical VA may result in all of the following except:

    1. a.

      Focal peak systolic velocity increase (≥100 cm/s)

    2. b.

      Intra-stenotic flow reversal

    3. c.

      Aliasing artifacts

    4. d.

      Flow lumen narrowing

  3. 3.

    The following criteria may help in discriminating VA hypoplasticity from VA occlusion:

    1. a.

      Low PSV in combination with high pulsatility along the entire VA

    2. b.

      Decreased vessel diameter relative to the other side

    3. c.

      Undisturbed color-flow signals

    4. d.

      Focal color-flow signal void

  4. 4.

    Color duplex scanning of the VA does not help:

    1. a.

      Identify patients with arterial obstructions

    2. b.

      Differentiate among several types of vasculitis

    3. c.

      Determine stroke pathogenic mechanism

    4. d.

      Identify patients with different grades of subclavian steal

  5. 5.

    The following findings may occur in subclavian steal except:

    1. a.

      Bunny rabbit waveform

    2. b.

      Double lumen

    3. c.

      Alternating flow

    4. d.

      Complete flow reversal

Answer Key

  1. 1.

    c

  2. 2.

    b

  3. 3.

    d

  4. 4.

    b

  5. 5.

    b

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Barlinn, J., Barlinn, K., Alexandrov, A.V. (2017). Color Duplex Scanning of Vertebral Artery. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_14

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  • DOI: https://doi.org/10.1007/978-3-319-54760-2_14

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-54758-9

  • Online ISBN: 978-3-319-54760-2

  • eBook Packages: MedicineMedicine (R0)

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