Associated Cardiovascular Consultants, P.A.

Carotid Doppler Testing

A discussion with Dr. Robert Singer, M.D., Associated Cardiovascular Consultants, P.A.

Carotid Doppler testing can provide a window on the vasculature of the body because the discovery of carotid stenosis can be an indicator of coronary artery disease (CAD) or peripheral vascular disease (PVD) elsewhere.

Dr. Robert Singer said physicians of Associated Cardiovascular Consultants conducted about 1,200 carotid 2D-Doppler tests last year. The simple non-invasive test takes 25 to 30 minutes, during which the patient lies supine, ultrasound jelly is applied, and an ultrasound probe is placed on the neck. The procedure causes no pain or discomfort and is an effective screening modality for plaque in the carotid arteries.

"The test could indeed be life saving," Dr. Singer said. "Carotid Doppler is being done more and more."

The testing is indicated when a patient presents with neurological symptoms associated with stroke or when examination detects a cervical bruit in the arteries. However, the steps to take after a blockage is discovered depend on a variety of factors, Dr. Singer explained.

"If the blockage is less than 70 percent, a period of watchful waiting is in order," Dr. Singer said. During that period, a program of lipid management and cholesterol lowering is initiated to reduce the risk of ischemic stroke.

Endarterectomy

In cases in which the vessel is more than 70-percent blocked, more aggressive treatment is indicated for both asymptomatic and symptomatic patients. If the blockage is discovered in a patient who has no symptoms, it is time for endarterectomy. Studies have shown, however, that such patients must be placed "good hands." The surgeons who participated in the carotid surgery trials were high-volume experienced technicians with low mortality rates for the procedures they performed. For example, the 30-day mortality rate was 0.6 percent in the North American Symptomatic Carotid Endarterectomy Trial (NASCET) and 0.1 percent in the Asymptomatic Carotid Atherosclerosis Study (ACAS).

Patients with blockages of 70 percent or greater may also be referred for angiography or magnetic resonance angiography (MRA). These tests are also useful diagnostic tools, but they are more invasive and more expensive while Doppler testing is quicker and safer, according to Dr. Singer.

Stenting

The use of stents in patients with carotid artery disease is on the increase, Dr. Singer said, and, in his view, the procedure has advantages. "The risk of stroke is the same as for surgery, but there is no cutting and less recuperation time." He pointed out that studies demonstrating the efficacy of stenting were conducted "on the sickest patients."

"I'm confident that's the way to go. It's not going to be surgery."

2D-Doppler screening for carotid artery disease defines what plaques look like. The tests indicate, for example, if the patient has fatty plaques that are likely to rupture or ulcerative plaques that can give rise to blood clots. "2D shows this and gives an indication of the next step," Dr. Singer said.

The presence of heart disease or cardiovascular disease in many cases may trigger carotid Doppler testing.

Carotid Doppler is also being used to screen patients for CAD. The Carotid Intima Media Test (CIMT) is used to measure the intima and media of the carotid arteries. Abnormalities in the thickness of these structures can be an indication of cardiovascular disease.

In summary:

  • Carotid Doppler testing is a safe and effective screening procedure not only for carotid stenosis but also for coronary artery disease and peripheral vascular disease.
  • Endarterectomy is beneficial provided patients are referred to experienced surgeons.
  • The use of stents to treat carotid artery disease is increasing.

A take home message about…..

Carotid Doppler Testing

  • Carotid Doppler testing is a simple procedure that opens a window on the body's vasculature.
  • The presence of heart disease or coronary artery disease should trigger carotid Doppler testing.
  • Carotid Doppler testing could indeed be life saving.

 

About the doctor

Dr. Robert A. Singer received his medical degree from SUNY Health Science Center in Brooklyn, N.Y., and completed a fellowship in cardiology at Hahnemann University Hospital in Philadelphia. A fellow of the American College of Cardiology, he has served on the executive committee of the Camden County Medical Society. He currently serves as the Chief of Cardiology and Head of Non-invasive Cardiology Labs for the Virtua-West Jersey Health System. Dr. Singer has co-authored articles for the American Journal of Roentenology, The Journal of Invasive Cardiology, and Anesthesia and Analgesia. Dr. Singer sees patients in ACC's Voorhees office.

 

© 2004 - Associated Cardiovascular Consultants, PA. All Rights Reserved.

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