ABC | Volume 112, Nº6, June 2019

Statement Vascular Ultrasound Statement from the Department of Cardiovascular Imaging of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(6):809-849 Figure 2 – Right carotid and its anatomical subdivisions recommended by the group (adapted from the Mannheim study).9 CC: common carotid; IB: internal branch; BCA: brachiocephalic artery. Internal branch External branch Intracranial part Distal IB Medial IB Proxi mal IB Bifurcation Distal CC Proxi mal CC BCA Clavicle in CCA and staccato flow – flow with minimal velocity and very high-resistance at the occlusion or pre-occlusion site. 1 The study group from DCI-BSC suggests the use of table 6 to quantify ICA stenosis. 1 2.4.1.2. Quantification of Carotid Stenosis with Anatomic Parameters The anatomical criterion (Figure 6) is based on the assessment of lumen reduction and should be used to characterize, in particular, stenosis below 50% (without hemodynamic repercussion); however, it is also a great contributor in stenosis greater than 50%, in which the hemodynamic criterion can fail to quantify stenosis accurately (e.g., severe aortic stenosis, significant contralateral carotid stenosis, among others). Lumen reduction is preferentially measured by diameter, and the result of the carotid stenosis range should be reported in intervals of 10%. It is recommended not to measure plaques smaller than 20% to avoid possible differences in the measurement of diameter reduction when the thickened intima is included or stopped being included. 1 2.4.2. Circumstances that Can Change the Measurement of Flow Velocities and Anatomic Evaluation Velocity evaluation can be compromised in some situations that affect measurements of spectral analysis. They can be located in the carotid bifurcation – distal or proximal – or even, in the contralateral carotid. Among the conditions proximal to the bifurcation, we underline aortic valve diseases (stenosis or insufficiency), atherosclerotic stenosis, or arteritis with involvement of the aortic arch, branches, and common carotid 1 (Table 7). Anatomic evaluation can be affected in circumstances such as arterial calcification with acoustic shadowing, improper adjustment of equipment, among others. 2.4.3. Report Description Relevant information for the report: • Specify the type of transducer used. • Inform the technical quality of the examination (report situations that can lower its quality – e.g., presence of catheters). • Describe the presence of atherosclerotic plaques, their location, extension, morphological characteristics, and degree of stenosis – quantified in deciles according to the DCI-BSC recommendation. 1 • Report other findings of or related to carotid arteries (e.g., tortuosities, dissections, tumors, arteritis). 2.5. Ultrasound Assessment After Carotid Intervention Treatment of symptomatic and asymptomatic carotid atherosclerotic disease has been the subject of multidisciplinary debate. Interventional treatment can be done by carotid endarterectomy or carotid stenting. Ultrasound is the examination of choice for the follow- up after carotid intervention, and its protocol has the same sequence of the examination of carotid arteries without intervention, with some peculiarities in the intervention site. For more information about what to report on the vascular intervention site, the basic protocol of ultrasound follow-up, and velocity parameter tables, we suggest consulting the DCI recommendations recently published. 1 817