—Tortuous vessels are known to hinder the accuracy of extracranial carotid duplex ultrasound evaluations, yet the prevalence and location of hemodynamically significant lesions in these patients is relatively unknown. We evaluated the frequency and location of significant carotid occlusive disease in duplex ultrasound patients with carotid artery tortuosity.
Methods
—Data from consecutive patients for a 7-month period were prospectively entered into a database. Only initial studies were included in this study. Follow-up examinations, endarterectomy or stent vessels, and internal carotid artery (ICA) occlusions were excluded from analysis. Tortuosity was classified according to the angle of vessel curvature, i.e., between 60° and 90° (C1); 30° and 60° (C2); less than 30° (C3), and the location of the area of maximum stenosis in relationship to the area of tortuosity, i.e., pre- (S1), intra- (S2), or post- (S3) tortuosity. Lesions causing ≥50% diameter reduction (>125 cm/sec) were considered hemodynamically significant (HSIG).
Results
—A total of 200 patients and 370 vessels were analyzed. ICA tortuosity was found in 22% (82/370) of all vessels analyzed. Classification of the angle of vessel curvature for vessels with tortuosity was C1-50% (41/82), C2-40% (33/82), and C3-10% (8/82). HSIG disease was found in 17% (48/288) of nontortuous and 10% (8/82) of tortuous ICA vessels (p = 0.172). The level of maximum stenosis preceded the area of tortuosity (S1) in all tortuous ICA vessels with HSIG disease.
Conclusions
—In this study, vessel tortuosity affected nearly a quarter of all vessels analyzed. The frequency of significant carotid disease was similar for patients with tortuous and nontortuous vessels. The location of maximum stenosis occurred before the area of curvature in all tortuous vessels with hemodynamically significant internal carotid artery disease, suggesting that this area should be the primary region of interest when evaluating duplex ultrasound patients with carotid artery tortuosity.
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