[Carotid dissection. Study of 28 cases. Contribution of Doppler exploration, ultrasonic diagnosis and Doppler color echography].

Carotid dissections often go undetected or are confused with an arteriosclerotic cause; in fact, they rarely require surgical treatment. Twenty-eight extracranial carotid dissections (in 25 patients) without direct cervical traumatism were explored successively by pulsed and duplex Doppler ultrasonography complemented in 10 cases by color Doppler flow imaging and secondarily in all cases by arteriography. Pulsed Doppler (DMS Angiodop 481 with 4 and 8 MHz probes) found severe hemodynamic signs in 93% of cases: 6 occlusions, 11 generally extensive or high tight stenoses and 9 significant slowdowns in carotid and ophthalmic artery circulation. For the same internal carotid artery, duplex Doppler (Ultramark 4 or Sonedap 40 with 5, 7.5 and 10 MHz probes) initially showed 5 occlusions and 2 stenoses (4 with fusiform features), 2 double canal images, 8 internal carotid arteries with tubular features (internal caliber less than or equal to 2 mm) and 2 segmental ectasias. There were only 3 other lesions with arteriosclerotic features, 2 of which were minor. Duplex imaging was thus suggestive in 57% of cases. Color Doppler flow imaging enabled precise visualization of these features, better analysis of occlusions and clear detection of 2 other false canal images. After 2 years of follow-up, Doppler ultrasound showed recanalization in 47% of cases with no anticoagulant complications. These combined ultrasonic explorations would thus appear to be useful for early diagnosis of carotid dissections, for guiding arteriography and for facilitating the monitoring of patients under anticoagulant.