Volume 48, Issue 3 September 2024 JVU 483-162 | Indirect Duplex Ultrasound Diagnosis of Innominate Artery Occlusive Disease-Volume 48, Issue 3 September 2024 JVU 483-162 | Indirect Duplex Ultrasound Diagnosis of Innominate Artery Occlusive Disease

Volume 48, Issue 3 September 2024 JVU 483-162 | Indirect Duplex Ultrasound Diagnosis of Innominate Artery Occlusive Disease

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The case report discusses a 69-year-old male patient with suspected transient ischemic attacks who was referred to the vascular lab for an assessment of the extracranial cerebrovascular arteries. His medical history included systemic hypertension, diabetes, and Parkinson’s disease, and symptoms of multiple syncopal events and balance problems. Previous radiological examinations, including a non-contrast computed tomographic angiogram (CTA) and magnetic resonance angiography (MRA), had proved inconclusive due to motion artifacts and failed visualization of some critical arteries.<br /><br />A duplex ultrasound (DUS) examination was subsequently conducted, revealing the momentary flow reversal in the right common carotid artery (CCA) and internal carotid artery (ICA), signs of subclavian steal syndrome, and indirect evidence of innominate artery (IA) stenosis or occlusion. The left side showed calcified ICA plaque but otherwise normal flow patterns, confirming a significant abnormality on the right side. <br /><br />The IA, also known as the brachiocephalic artery, is the first branch off of the aortic arch. The report highlights the difficulties of direct IA assessment due to its anatomical positioning and suggests that indirect duplex ultrasound techniques, which observe characteristics like oscillatory blood flow patterns and dampened waveforms, provide reliable but indirect evidence of IA occlusion.<br /><br />Furthermore, three types of ischemia associated with IA occlusive disease are discussed, with this patient’s case classified as Type III–showing the most severe symptoms. The study concludes that duplex ultrasound, when used in combination with contrast imaging modalities like CTA and MRA, serves as a valuable diagnostic tool prior to surgical intervention.<br /><br />The findings underscore the diagnostic value of DUS in identifying IA occlusive disease, serving as a crucial confirmatory step when other imaging modalities are inconclusive. The study also acknowledges the limitations of indirect methods in providing detailed assessments like plaque morphology or vessel geometry but supports their utility in initial diagnostic workflows.

Keywords

transient ischemic attacks

duplex ultrasound

subclavian steal syndrome

innominate artery stenosis

computed tomographic angiogram

magnetic resonance angiography

systemic hypertension

Parkinson’s disease

ischemia

diagnostic imaging