American Journal of Roentgenology, Vol 166, 197-202, Copyright © 1996 by American Roentgen Ray Society

ARTICLES

Duplex sonography of the carotid arteries in patients with isolated aortic stenosis: imaging findings and relation to severity of stenosis

MK O'Boyle, NI Vibhakar, J Chung, WD Keen and BB Gosink
Department of Radiology, Veterans Affairs Medical Center, San Diego, CA 92161, USA.

OBJECTIVE. The purposes of this study were to identify carotid artery duplex waveform abnormalities in patients with isolated aortic stenosis and to determine whether waveform abnormalities correlate with the severity of valvular disease. MATERIALS AND METHODS. Twenty-four patients with various degrees of aortic stenosis diagnosed by echocardiography and/or cardiac catheterization had preoperative carotid artery duplex sonograms that were retrospectively reviewed for acceleration time, peak velocity, waveform contour, upstroke delay, and presence of a dicrotic notch and a second systolic peak. Data were collected for the right and left internal, external, and common carotid arteries separately. These findings were correlated with aortic valve area and compared with data for a control group of 11 age-matched patients with normal echocardiographic findings. Two additional patients with isolated aortic stenosis diagnosed by echocardiography and/or cardiac catheterization were prospectively evaluated in a similar fashion, with acceleration time being calculated directly from the sonography unit. RESULTS. Unlike the patients with mild or moderate stenosis, the patients with critical or severe stenosis had a mean acceleration time that was significantly longer than that in the control subjects (p = .008-.0001). Peak velocities were decreased in all cases of aortic stenosis regardless of severity only in the common carotid arteries. All 13 patients with critical aortic stenosis had delayed upstrokes and rounded waveforms in the common, internal, and external carotid arteries. Twenty percent (one of five) of the patients with severe stenosis and 17% (one of six) of the patients with moderate or mild stenosis also had these characteristics. The two prospectively evaluated patients, who had critical and severe aortic stenoses, had similar findings. None of the control subjects showed these abnormalities. The presence or absence of a second systolic peak or a dicrotic notch was not different between patients with aortic stenosis and control subjects. CONCLUSION. Increased acceleration time, decreased peak velocity, delayed upstroke, and rounded waveform are characteristic abnormalities found in duplex sonographic studies of the carotid arteries in patients with aortic stenosis. The degree of each of these abnormalities correlates with the valve area. Patients with critical or severe aortic stenosis had findings significantly different from those in the control group. Patients with mild or moderate disease showed few or no sonographic abnormalities.
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