Practical noninvasive neurovascular imaging of the neck arteries in patients with stroke, transient ischemic attack, and suspected arterial disease that may lead to ischemia, infarction, or flow abnormalities.

Stroke is the third leading cause of death in the United States, killing nearly 157,000 people a year with an estimated society cost of dollar 58 billion in 2006. A large percentage of ischemic strokes is secondary to extracranial carotid and vertebral arterial disease. While digital subtraction angiography has traditionally been used for the initial evaluation of the degree of stenosis, noninvasive imaging has moved to the forefront in the extracranial arterial evaluation. The importance of understanding the imaging techniques, findings, interpretation, artifacts, and pitfalls is essential to appropriate patient management.

[1]  E. Raps,et al.  Carotid and vertebral artery dissections. , 1997, Emergency medicine clinics of North America.

[2]  L. Caplan Posterior circulation disease : clinical findings, diagnosis, and management , 1996 .

[3]  C. Bartolozzi,et al.  Contrast-Enhanced Three-Dimensional Magnetic Resonance Angiography of Atherosclerotic Internal Carotid Stenosis as the Noninvasive Imaging Modality in Revascularization Decision Making , 2003, Stroke.

[4]  J. Slattery,et al.  Equivalence of Measurements of Carotid Stenosis: A Comparison of Three Methods on 1001 Angiograms , 1994, Stroke.

[5]  L. Caplan Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. , 2000, Stroke.

[6]  R. Peto,et al.  Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial , 2004, The Lancet.

[7]  C. Matula,et al.  Colour doppler imaging of partial subclavian steal syndrome , 2004, Neuroradiology.

[8]  J. Slattery,et al.  Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST) , 1998, The Lancet.

[9]  W. Mali,et al.  Maximum internal carotid arterial stenosis: assessment with rotational angiography versus conventional intraarterial digital subtraction angiography. , 1999, Radiology.

[10]  F. Moll,et al.  Ultrasonographic characterization of carotid plaques. , 1998, Ultrasound in medicine & biology.

[11]  Mervi Könönen,et al.  Carotid stenosis degree in CT angiography: assessment based on luminal area versus luminal diameter measurements , 2005, European Radiology.

[12]  M. Mcclurken,et al.  Natural history of asymptomatic carotid plaque. Five year follow-up study. , 1987, American journal of surgery.

[13]  C. Warlow,et al.  MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis , 1991, The Lancet.

[14]  G. Donnan,et al.  Is carotid angiography necessary? Editors disagree , 2003 .

[15]  V. Servois,et al.  Carotid and vertebral artery dissections: three-dimensional time-of-flight MR angiography and MR imaging versus conventional angiography. , 1994, Radiology.

[16]  P. Humphrey,et al.  Complications of cerebral angiography in patients with symptomatic carotid territory ischaemia screened by carotid ultrasound. , 1993, Journal of neurology, neurosurgery, and psychiatry.

[17]  W. Thies,et al.  When to operate in carotid artery disease. , 2000, American family physician.

[18]  S J Riederer,et al.  Carotid artery: elliptic centric contrast-enhanced MR angiography compared with conventional angiography. , 2001, Radiology.

[19]  D Saloner,et al.  Structure of Plaque at Carotid Bifurcation: High-Resolution MRI With Histological Correlation , 2001, Stroke.

[20]  K D Hopper,et al.  CT angiographic measurement of the carotid artery: optimizing visualization by manipulating window and level settings and contrast material attenuation. , 2000, Radiology.

[21]  C. Bartolozzi,et al.  Contrast-enhanced three-dimensional MR angiography of neck vessels: does dephasing effect alter diagnostic accuracy? , 2003, European Radiology.

[22]  L. Caplan,et al.  Efficacy of MR Angiography in the Detection and Characterization of Occlusive Disease in the Vertebrobasilar System , 2001, Journal of computer assisted tomography.

[23]  P. Wolf,et al.  Epidemiologic features of isolated syncope: the Framingham Study. , 1985, Stroke.

[24]  J. Pruvo,et al.  Recent advances in magnetic resonance angiography of carotid and vertebral arteries. , 2000, Current opinion in neurology.

[25]  G. Hankey,et al.  Cerebral angiographic risk in mild cerebrovascular disease. , 1990, Stroke.

[26]  D G Mitchell,et al.  Color Doppler imaging: principles, limitations, and artifacts. , 1990, Radiology.

[27]  Stephen J. Riederer,et al.  Contrast-Enhanced Magnetic Resonance Angiography of the Cervical Vessels: Experience With 422 Patients , 2001, Stroke.

[28]  M. Bernstein,et al.  Evaluation of classic 2D time-of-flight MR angiography in the depiction of severe carotid stenosis. , 2004, AJR. American journal of roentgenology.

[29]  W. Kapoor,et al.  CLINICAL GUIDELINE: Diagnosing Syncope: Part 1: Value of History, Physical Examination, and Electrocardiography , 1997, Annals of Internal Medicine.

[30]  S. Riederer,et al.  Carotid artery: prospective blinded comparison of two-dimensional time-of-flight MR angiography with conventional angiography and duplex US. , 1993, Radiology.

[31]  B. Giraudeau,et al.  Accuracy of Color-Doppler in the Quantification of Proximal Vertebral Artery Stenoses , 2001, Cerebrovascular Diseases.

[32]  Torben V. Schroeder,et al.  Ultrasonic Echolucent Carotid Plaques Predict Future Strokes , 2001, Circulation.

[33]  J. Bamford,et al.  Classification and natural history of clinically identifiable subtypes of cerebral infarction , 1991, The Lancet.

[34]  L. Caplan Vertebrobasilar occlusive disease , 1992 .

[35]  Chun Yuan,et al.  In vivo accuracy of multispectral magnetic resonance imaging for identifying lipid-rich necrotic cores and intraplaque hemorrhage in advanced human carotid plaques. , 2002 .

[36]  D. Dormont,et al.  Proximal great vessels of aortic arch: comparison of three-dimensional gadolinium-enhanced MR angiography and digital subtraction angiography. , 2003, Radiology.

[37]  B. Tom,et al.  Contrast-enhanced MR angiography for carotid disease , 2004, Neurology.

[38]  D. Sackett,et al.  Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. North American Symptomatic Carotid Endarterectomy Trial Collaborators. , 1998, The New England journal of medicine.

[39]  B. Bloem,et al.  Magnetic resonance imaging and vertebral artery dissection , 1999, Journal of neurology, neurosurgery, and psychiatry.

[40]  A. Buchan,et al.  *North American Symptomatic Carotid Endarterectomy Trial (NASCET) Steering Committee. Beneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis. , 1991 .

[41]  V. Fuster,et al.  Clinical Imaging of the High-Risk or Vulnerable Atherosclerotic Plaque , 2001, Circulation research.

[42]  J. Wardlaw,et al.  Outcome, observer reliability, and patient preferences if CTA, MRA, or Doppler ultrasound were used, individually or together, instead of digital subtraction angiography before carotid endarterectomy , 2002, Journal of neurology, neurosurgery, and psychiatry.

[43]  E. Potchen,et al.  Physical principles and application of magnetic resonance angiography. , 1992, Seminars in ultrasound, CT, and MR.

[44]  David A. Steinman,et al.  Effect of Contralateral Carotid Artery Stenosis on Carotid Ultrasound Velocity Measurements , 2000, Stroke.

[45]  C. Kramer,et al.  Calcified carotid atherosclerotic plaque is associated less with ischemic symptoms than is noncalcified plaque on MDCT. , 2005, AJR. American journal of roentgenology.

[46]  J M Johnson,et al.  Natural history of asymptomatic carotid plaque. , 1985, Archives of surgery.

[47]  Stoney Rj,et al.  Recurrent carotid stenosis. , 1976 .

[48]  C. Kitanaka,et al.  Magnetic Resonance Imaging Study of Intracranial Vertebrobasilar Artery Dissections , 1994, Stroke.

[49]  J M Stevens,et al.  Reproducibility of Computer-Quantified Carotid Plaque Echogenicity: Can We Overcome the Subjectivity? , 2000, Stroke.

[50]  J. Mohr,et al.  Interrater reliability of plaque morphology classification in patients with severe carotid artery stenosis , 1999, Acta neurologica Scandinavica.

[51]  Z. Bosanac,et al.  Rotational digital subtraction carotid angiography: technique and comparison with static digital subtraction angiography. , 1998, Clinical radiology.

[52]  W. Moore For severe carotid stenosis found on ultrasound, further arterial evaluation is unnecessary. , 2003, Stroke.

[53]  C. Yuan,et al.  Visualization of Fibrous Cap Thickness and Rupture in Human Atherosclerotic Carotid Plaque In Vivo With High-Resolution Magnetic Resonance Imaging , 2000, Circulation.

[54]  J. Brunberg,et al.  3D gadolinium-enhanced MR angiography of the carotid arteries. , 1996, Magnetic resonance imaging.

[55]  L. Caplan,et al.  Current concepts: Vertebrobasilar disease , 2005 .

[56]  P. Nederkoorn,et al.  Carotid artery stenosis: accuracy of contrast-enhanced MR angiography for diagnosis. , 2003, Radiology.

[57]  C. Yutani,et al.  Rupture of atheromatous plaque as a cause of thrombotic occlusion of stenotic internal carotid artery. , 1987, Stroke.

[58]  Javier M Romero,et al.  Noninvasive evaluation of carotid artery stenosis: indications, strategies, and accuracy. , 2005, Neuroimaging clinics of North America.

[59]  P. Nederkoorn,et al.  Systematic Review of Computed Tomographic Angiography for Assessment of Carotid Artery Disease , 2004, Stroke.

[60]  Evaluation of contrast densities in the diagnosis of carotid stenosis by CT angiography. , 1997, AJR. American journal of roentgenology.

[61]  J. Szaflarski,et al.  Stroke in a Biracial Population: The Excess Burden of Stroke Among Blacks , 2004, Stroke.

[62]  W. Kapoor,et al.  CLINICAL GUIDELINE: Diagnosing Syncope: Part 1: Value of History, Physical Examination, and Electrocardiography , 1997, Annals of Internal Medicine.

[63]  David H. Kim,et al.  Vertebral artery Doppler waveform changes indicating subclavian steal physiology. , 2000, AJR. American journal of roentgenology.

[64]  A. Okumura,et al.  The clinical utility of contrast-enhanced 3D MR angiography for cerebrovascular disease , 2001, Neurological research.

[65]  M. Koltzenburg,et al.  Silent embolism in diagnostic cerebral angiography and neurointerventional procedures: a prospective study , 1999, The Lancet.

[66]  J. Gillard,et al.  Imaging the vertebral artery , 2005, European Radiology.

[67]  J. Eastwood,et al.  Contrast-Enhanced Magnetic Resonance Angiography of Carotid Arteries: Utility in Routine Clinical Practice , 2002, Stroke.

[68]  A. Alexandrov,et al.  Carotid Artery Stenosis: Grayscale and Doppler Ultrasound Diagnosis—Society of Radiologists in Ultrasound Consensus Conference , 2003, Ultrasound quarterly.

[69]  K. Furie,et al.  Potential influence of acute CT on inpatient costs in patients with ischemic stroke. , 2001, Academic radiology.

[70]  R F Busse,et al.  Carotid arteries: maximizing arterial to venous contrast in fluoroscopically triggered contrast-enhanced MR angiography with elliptic centric view ordering. , 1999, Radiology.

[71]  J. Jeng,et al.  Imaging in the diagnosis and follow‐up evaluation of vertebral artery dissection. , 2000, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[72]  P. Sidhu,et al.  Ultrasound of the carotid and vertebral arteries. , 2000, British medical bulletin.

[73]  W S Moore,et al.  Recurrent carotid stenosis : results of the asymptomatic carotid atherosclerosis study. , 1998, Stroke.

[74]  C. Derdeyn Catheter angiography is still necessary for the measurement of carotid stenosis. , 2003, AJNR. American journal of neuroradiology.

[75]  L. Pazdera,et al.  New England medical center posterior circulation registry , 2004, Annals of neurology.

[76]  J. Mohr,et al.  Stroke : pathophysiology, diagnosis, and management , 2004 .

[77]  P. Davis,et al.  A prospective comparison of duplex sonography vs angiography of the vertebral arteries. , 1986, AJNR. American journal of neuroradiology.

[78]  D. Sackett,et al.  Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. , 1991, The New England journal of medicine.

[79]  L. White,et al.  The Clinical Efficacy Assessment Project of the American Collegeof Physicians , 1985, International Journal of Technology Assessment in Health Care.

[80]  M. Reiser,et al.  Improved diagnosis of vascular dissection by ultrasound B-flow: a comparison with color-coded Doppler and power Doppler sonography , 2005, European Radiology.

[81]  D. Kallmes,et al.  Accuracy and precision of CT angiography in a model of carotid artery bifurcation stenosis. , 1997, AJNR. American journal of neuroradiology.

[82]  F. Dubas,et al.  Extracranial and intracranial vertebrobasilar dissections: diagnosis and prognosis , 1997, Journal of neurology, neurosurgery, and psychiatry.

[83]  P. Yip,et al.  Subclavian steal phenomenon: a correlation between duplex sonographic and angiographic findings , 2004, Neuroradiology.

[84]  Javier M Romero,et al.  Total occlusion versus hairline residual lumen of the internal carotid arteries: accuracy of single section helical CT angiography. , 2003, AJNR. American journal of neuroradiology.

[85]  Glenn B. Anderson,et al.  CT Angiography for the Detection and Characterization of Carotid Artery Bifurcation Disease , 2000, Stroke.

[86]  L. See,et al.  Multisection CT angiography compared with catheter angiography in diagnosing vertebral artery dissection. , 2004, AJNR. American journal of neuroradiology.

[87]  P. Rothwell,et al.  Prognosis of vertebrobasilar transient ischaemic attack and minor stroke. , 2003, Brain : a journal of neurology.

[88]  V. Fuster,et al.  The diagnostic accuracy of ex vivo MRI for human atherosclerotic plaque characterization. , 1999, Arteriosclerosis, thrombosis, and vascular biology.

[89]  Juan Alvarez-Linera,et al.  Prospective evaluation of carotid artery stenosis: elliptic centric contrast-enhanced MR angiography and spiral CT angiography compared with digital subtraction angiography. , 2003, AJNR. American journal of neuroradiology.

[90]  L. Caplan Vertebrobasilar transient ischemic attacks. , 1985, Archives of neurology.

[91]  J. Slattery,et al.  Prognostic Value and Reproducibility of Measurements of Carotid Stenosis: A Comparison of Three Methods on 1001 Angiograms , 1994, Stroke.

[92]  J. Romero CT angiography source image evaluation for stroke. , 2005, Seminars in ultrasound, CT, and MR.

[93]  H E Cline,et al.  3DFT MR angiography of carotid and basilar arteries. , 1989, AJNR. American journal of neuroradiology.

[94]  Seymour Glagov,et al.  Degree of carotid plaque calcification in relation to symptomatic outcome and plaque inflammation. , 2004, Journal of vascular surgery.

[95]  Markus Horn,et al.  Preoperative evaluation of carotid artery stenosis: comparison of contrast-enhanced MR angiography and duplex sonography with digital subtraction angiography. , 2003, AJNR. American journal of neuroradiology.

[96]  G. Scotti,et al.  Carotid artery stenosis: intraindividual correlations of 3D time-of-flight MR angiography, contrast-enhanced MR angiography, conventional DSA, and rotational angiography for detection and grading. , 2005, Radiology.