Doppler ultrasonography of BCA, what is duplex scanning of brachiocephalic arteries and blood

Doppler ultrasound of BCA or BCS stands for ultrasound dopplerography of the bracheocephalic arteries (BCA) or blood vessels (BCS). Bracheocephalic arteries are blood supply systems that supply blood from the aorta to brain tissue through the neck. They are localized in the cervical spine. Their study is carried out using a special sensor that emits ultrasonic waves.

The method is based on the famous Doppler effect, which is often used in medicine for diagnostic purposes. Ultrasonic waves are reflected from moving substances and, depending on the intensity of mass movement, give an image of various densities to the monitor screen (the density range is expressed by the color intensity: from white to black).

Using this examination method, a specialist can identify:

  • the presence of atherosclerotic plaques;
  • blood circulation intensity;
  • the nature of damage to the vascular walls (if there is a pathology);
  • the presence of artery stenosis;
  • the presence of aneurysms on the walls of blood vessels (these are local thinning of the epithelium, as a result of which it “swells” and disrupts the uniform blood flow, it begins to move with “swirls”, and excess cholesterol settles in hollow places).

The main purpose of the examination is to identify lesions of the vessels of the neck and head in the early stages, in order to carry out the necessary treatment in time and prevent a brain stroke. This condition is dangerous spontaneous death. And it begins, as a rule, with the usual violation of full blood supply due to pathologies of the vascular bed of the neck.

Among all the available methods for examining the walls of blood vessels, an ultrasound scan of the BCC is the most affordable. Firstly, it is relatively cheap, the average price is from 500 to 5000 rubles. Secondly, in almost every clinic there is the necessary equipment for the procedure.

All vessels of the bracheocephalic arteries bear a similar name. Simply put, these are the vessels of the neck through which blood enters the cranium and through which it is then withdrawn back in the form of venous blood.

Doppler ultrasound is prescribed in the following cases:

  • atherosclerosis;
  • osteochondrosis of the cervical spine;
  • cerebral vascular disease;
  • migraine.

In the absence of the above diagnoses, the technique can be prescribed by a doctor in the presence of the following symptoms, when there is a possibility of the presence of circulatory pathologies in the cervical spine:

  1. Frequent headaches.
  2. Pain in the neck.
  3. Darkening in the eyes with a sharp change in body position in space.
  4. “Flies” before my eyes.
  5. Noise in ears.

Based on the research data, the doctor finds out the cause of the described symptoms and prescribes treatment. In most cases, they are associated with a violation of the blood supply to the brain.

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contraindications

The only contraindication for the study are deep neck injuries. In other cases, TCD is allowed, since the method is not invasive and absolutely safe. It is allowed even for women during pregnancy and breastfeeding. Children’s age is also not a contraindication.

Features of the structure

So, in order to understand what brachiocephalic arteries are, it is necessary to trace their path directly from the aorta to the brain. The blood flow coming from the aortic arch is distributed into three large arteries:

  • general carotid (departs from the left side);
  • left subclavian;
  • brachiocephalic trunk (departs from the right side).

The brachiocephalic trunk, in turn, branches out into three arteries located on the right side:

All these arteries, directly or indirectly, participate in the blood supply to the shoulder girdle and brain, forming a complex system, which is a vicious circle, and allows you to evenly redistribute the entire volume of incoming blood to ensure uniform blood supply to all parts of the brain. Violation of blood flow in any of the vascular pools, leads to a redistribution of incoming blood either bypassing the Wellis circle, or creating a reverse direction of blood flow, leading to insufficient blood supply to the brain. A similar effect is called “robbery.”

Important! The average diameter of the main arteries ranges from 6–8 mm, while the minimum acceptable border below which pathological changes in blood vessels is diagnosed is 4 mm.

Anatomical location of the brachiocephalic arteries

Indications for ultrasound of brachiocephalic vessels

  • Hypertension;
  • Atherosclerosis;
  • Suspicion of plaques and blood clots in the vessels;
  • Diseases of the blood;
  • Injuries and pathologies of the development of the cardiovascular system;
  • Vegetative dystonia;
  • Infectious diseases;
  • Osteochondrosis of the cervical spine;
  • Pathology of the heart;
  • Injuries to the cervical spine.

It is also necessary to consult a doctor for an examination and, if necessary, subsequent appointment of an ultrasound scan of the brachiocephalic vessels with the following symptoms: frequent headaches and dizziness with neck movements, frequent loss of consciousness, weakness in the body, tinnitus, numbness of the limbs, increased cholesterol for a long period of time progressive visual impairment.

At risk for the development of diseases associated with pathologies of brachiocephalic vessels, there are also people with diabetes and those who are overweight. With heart diseases, vascular lesions, hypertension and atherosclerosis, as well as after suffering strokes and heart attacks, it is recommended to perform ultrasound of the brachiocephalic vessels in a planned manner every one to two years.

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It is advisable to come to the procedure 30 minutes before the appointed time in order to relax and calm down. Walking and physical activity affect the tone of the vessels and distort the results of the examination.

The procedure itself is carried out in a dedicated room. The doctor suggests the patient to strip to the waist and lie on the couch. A special gel is applied to the skin of the neck to facilitate the gliding of the device. The doctor drives the device sensor around the neck in different places. Be prepared that you will be asked repeatedly to roll over on your stomach, on your side. This is necessary for a comprehensive assessment of the condition of the cervical arteries.

The average duration of the procedure is 3-5 minutes. During this time, the doctor will have time to collect all the necessary data to assess the state of blood supply in the neck and make a diagnosis.

The device is absolutely safe, it emits only ultrasonic waves that are reflected from the internal environment of the body and provide data about them on a special monitor. The principle of operation of the equipment was described in more detail above.

BCA duplex scanning includes examination of extracarnial sections of the main arteries in a combined mode, combining β-mode and Dopplerography, as well as examination of transcarnial sections using the Doppler effect. Since the frequency of ultrasound used in the β-mode does not allow to assess the state of the walls of blood vessels located inside the skull, the diagnosis is carried out based on Doppler color indicators of the volume and speed of blood flow.

An examination of the arteries in order to determine the size of the CMM is performed according to the standard method. The patient, immediately before the procedure, should be lying on his back for at least 15 minutes, and only then begin an ultrasound examination of the common carotid artery.

At the same time, the head is moved slightly away from the sensor, and the sensor itself is leaned against the side of the neck without effort. At this point, a clear picture should appear on the monitor, which shows the front and far walls of the artery, with characteristic lines of intima-media. Measurement of the functional parameters of the arteries can be carried out simultaneously with the ECG, which allows you to determine the thickness of the CMM with extremely high accuracy (up to 0,01 mm).

To assess the condition of the endothelium, its ability to provide adequate resistance to blood flow, that is, to contract and stretch according to the phases of the cardiac cycle, the method of functional tests is used, the essence of which is to fix the data obtained as a result of exposure to the blood stream of various stimulants (medication or mechanical).

Nitroglycerin has a powerful, but short-term vasodilating effect

Similarly, a functional test is carried out using medications, for example, nitroglycerin. The reaction to taking the medication begins to be recorded after 15 seconds, and then at intervals of 1-3-5 minutes. A normal reaction to the use of functional tests is the expansion of the vessel (dilatation) not later than 15 seconds. The absence of vasodilation at 15 seconds is referred to as pathological conditions.

Despite the extremely high diagnostic value of the information received, BCA duplex scanning is a relatively inexpensive research method, the cost of which, taking into account the use of functional tests, usually does not exceed 5 rubles. The main condition that determines where to do BCA ultrasound scan is the presence of the latest generation ultrasound scanner in the selected clinic, the algorithm of which provides for synchronization of all actions with the ECG.

Decoding of the conclusion: norms and deviations

The results of this study are evaluated by the following indicators:

  1. Thickness and elasticity of the vascular walls. Normally, the thickness of the artery wall should be within 1 centimeter. If there are any abnormalities or local thickenings, then the doctor suggests the presence of atherosclerotic plaques.
  2. Blood flow rate. The maximum, which corresponds to the systolic phase of the heart and the minimum corresponding to diastole, is estimated. The indicator is estimated as the ratio of these two speeds. There is no single norm for an adult. It is identified by the doctor individually on the basis of anamnesis: the presence of concomitant diseases, abnormalities in the work of the heart, gender and age.

The protocol for duplex scanning of brachiocephalic vessels is interpreted by the attending physician. During decoding, the doctor checks the actual result of the examination with the age and anatomical norm of the structure of the BCA.

Norm of parameters
Types of ArteriesDiameter in millimetersDiastolic blood flow cm / secondSystolic blood speed cm / secResistance Index (speed ratio)
Vertebral2-4.66-2620-600.6-0,9
Sleepy general4,1-79-3650-105
Sleepy inner3-6.49-3532-1010.5-0.9
Sleepy outdoor3-6.16-2636-105

What changes in the BCA are shown by the duplex: Patency of the brachiocephalic arteries should be complete, and the diameter should be the same along the entire length of the examined area. An echo sign of pathologies is turbulence (turbulence, acceleration) of blood flow, vessel asymmetry.

  • aneurysm – on the wall of the artery there is a bag-like protrusion of more than 2 mm outward from the lumen, echogenicity does not change;
  • atherosclerosis – fatty plaques on the inner wall of a light gray color, narrowing the lumen of the vessel;
  • stenosis – narrowing of the diameter of the artery;
  • dissection – damage to the inner lining of the vessel, stratification of the wall, echogenicity of the tissue is reduced;
  • occlusion – partial or complete blockage of the artery with an atherosclerotic plaque, blood patency is low or absent;
  • extravasal compression – pressure on the outer wall of the artery by a tumor, a hernia of the intervertebral disc, a deformed bone, the dense elements are painted white;
  • inflammation – the walls of the artery are hypoechoic (darken), unevenly thicken.
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The study of BCA by ultrasound is also called ultrasound. A complete transcript in medicine is Doppler ultrasound of the brachiocephalic arteries. Brachiocephalic arteries are large vessels that provide blood supply to the head and neck, and the upper extremity girdle. Anatomically, they move away from the aortic trunk at the level of the shoulder joints.

The basis of the research methodology is the Doppler effect, which was discovered by a scientist from Austria and named in his honor. The ultrasound waves that the ultrasound probe emits are reflected from the blood cells that are constantly moving inside the vascular bed. As they approach the sensor, the pulse frequency increases, when moving away from it, it decreases. An image appears on the screen of the monitor, which makes it possible to visualize the state of the vascular trunks, as well as the speed of blood flow through them.

This survey technique has several advantages. Firstly, this is a non-invasive manipulation, so it is painless. Secondly, the examination does not take more than 10 minutes, which saves the patient time. Thirdly, the price of ultrasound is available to most patients. In addition to all this, the BCA ultrasound scan has a high degree of information – this makes it easier to make a correct diagnosis.

At the end of the examination, the doctor of functional diagnostics gives his opinion, certified by signature and seal. Deciphering the results of a BCA ultrasound in adults is carried out by comparing the data obtained during the examination with those indicated in the table of normal values. This table contains the average norms according to ultrasound, which reflect the state of the vascular bed.

Healthy vessels have a smooth, elastic wall, their lumen is uniform, without sections of stenosis. Blood moves smoothly without creating a turbulent current. The organ structures that are supplied by the normal vasculature receive adequate nutrition and oxygenation. With stenosis of the vessel, its lumen decreases, which greatly complicates the blood flow.

Coarctation is a pathological expansion of the vascular lumen. Such changes lead to the thinning of all layers of its wall, the formation of aneurysms. Atherosclerotic lesion is the deposition of lipid molecules on the endothelium of arteries. In this case, the blood flow is difficult, which becomes the cause of oxygen starvation of organs.

The conclusion issued by the doctor of functional diagnostics should be provided to your doctor. This will make it possible to make a diagnosis, prescribe the correct treatment. It should be remembered that the result of ultrasound scan is not a definitive diagnosis!

The data of this type of ultrasound together with a duplex examination are quite complete and reliable information about the state of the vessels of the head and neck. As a result of the diagnosis, the doctor can detect in the patient:

  1. problematic places in the vessels, such as blood clots, atherosclerotic plaques, and other BCA changes;
  2. abnormal location and structure of blood vessels (these problems are congenital or acquired, for example, the uneven course of the vertebral arteries, caused by osteochondrosis);
  3. problems with the outflow of blood through the veins from the brain to the heart muscle (some experts believe that this leads to multiple sclerosis and other serious diseases of the nervous system).

When deciphering the ultrasound data of BCA, the doctor estimates the blood flow in:

  • carotid arteries (common, external and internal);
  • vertebral artery;
  • suprablock and main arteries;
  • back, middle and front arteries of the brain;
  • subclavian artery;
  • back and front connecting arteries.
ArteryDiameter, mmRIV systolic.V diastolic.
Common carotid (OSA)4,2 – 6,90,6 – 0,850 – 1049,0 – 36
Internal carotid (ICA)3,0 – 6,30,5 – 0,832 – 1009,0 – 35
External carotid (NSA)3,0 – 6,00,6 – 0,937 – 1056,0 – 27
Vertebral (PA)2,0 – 4,40,6 – 0,820 – 616,0 – 27

The final conclusion may indicate a recommendation for transcranial duplex scanning of cerebral vessels. It gives the characteristics of the arteries that are located in the skull. But still, it is necessary to start looking for problems with the blood supply to the brain precisely with an ultrasound examination of the neck vessels. Only taking into account information about peripheral circulation can we get the right conclusions about the origin of problems with brain nutrition. To predict the possible development of pathologies, the characteristics of the walls of the carotid arteries are very important, they can be obtained by passing an ultrasound of the BCA.

Even if the ultrasound of the brachiocephalic arteries does not reveal serious problems, the doctor, according to the results of the ultrasound scan of the BCA, can give the patient advice that will help prevent a stroke and other troubles in the future. Also, the characteristics of blood circulation in the brain, indicated in the medical report according to the results of the examination, will help diagnose, if necessary, neurological diseases.

Ultrasound of the study of the main arteries is by far the most informative diagnostic method that can reveal not only physiological changes (wall deformations, width of the vascular bed, bends, presence of atherosclerotic plaques), but also qualitative and quantitative blood flow indices.

Ultrasound scanning used to diagnose pathologies of the brachiocephalic arteries can be divided into 2 types:

  • Doppler ultrasound (Doppler ultrasound);
  • duplex scanning.

Both methods are based on the Doppler effect, the essence of which is to fix the reflected ultrasonic wave from moving objects. In the case of blood flow studies, red blood cells act as moving objects that reflect ultrasound. The change in the frequency emitted by the sensor (Doppler shift) occurs in direct proportion to the speed of red blood cells moving along the bloodstream, while if the red blood cells move towards the sensor, the frequency increases and the sensor detects a positive shift, and if the sensor detects the frequency, the negative shift is recorded and fixed.

On the ultrasound monitor, this is reflected in the form of a color image of multidirectional blood flows – red (positive shift) and blue (negative shift). The BCA ultrasound method has both positive and negative sides. The positive should include the possibility of examining transcarnial parts of the brain, that is, arteries located inside the cranium, while this zone is inaccessible for classical ultrasound examination (β-mode).

The negative side is the impossibility of accurately determining the position of the vessel, and therefore the diagnostics are carried out based on its probable location and change in the scanning depth. In rare cases, with an anatomically uncharacteristic arrangement of the arteries, ultrasound scan cannot reflect blood flow, but this is not a clear sign of its actual absence.

Duplex scanning of brachiocephalic arteries is performed on ultrasound scanners of the latest generation, combining classical ultrasound in β-mode and dopplerography. Assessment of the condition of the arteries and the quality of blood flow is performed based on a two-dimensional (duplex scan) or three-dimensional (triplex scan) image. In this case, the vessel can be displayed in the transverse plane and in length.

What are the methods of the study?

Duplex scanning of brachiocephalic vessels (BCC) is carried out in order to detect pathological changes that lead to circulatory disorders or ischemia (oxygen starvation) of the brain:

  • arteriosclerosis of arteries;
  • structural changes (lengthening or deformation of blood vessels);
  • pathological narrowing of the lumen of the artery (stenosis);
  • localization, structure and size of cholesterol plaques;
  • direction and speed of blood flow;
  • mobility and elasticity of the artery;
  • the presence of a blood clot.

In Figure A – a thickening of the vessel wall, B – a large atherosclerotic plaque that covers more than 50% of the lumen of the vascular bed, C – a change in the direction of blood flow due to complete overlap of the lumen, G – deformation of the vessel

The method of ultrasonic dopplerography (Doppler ultrasound scanning) is based on measuring changes in the frequency of sound waves that are reflected from moving objects. In our case, these are blood cells. The ultrasound waves reflected from them are converted by the device into electrical impulses, which are then visualized. The study helps to determine the speed with which the blood moves in the vessels, how close the blood flow is to normal.

Doppler ultrasound of brachiocephalic vessels allows you to find out about their patency. Conclusions here are made on the basis of the data on the nature and direction of blood flow in the vessels, its speed. The result of the study is a graph.

The main causes of pathologies

The main cause of pathological changes in the vascular system, which make up more than 80% of all cases of circulatory disorders, are atherosclerotic lesions of BCA. Conducting ultrasound scans of BCS in people with relatively good health, showed the presence of an initial stage of atherosclerosis in 3% of the examined, whose age was 45-50 years. Such indicators indicate a high likelihood of ischemic stroke after 55-60 years.

Atherosclerotic changes are also an indirect cause of structural deformations of blood vessels, for example, the appearance of crimp. Since the formation of atherosclerotic plaques on the inner surface of the vascular wall (endothelium) leads not only to a narrowing of the lumen and, accordingly, hemodynamic disturbances, but also to a loss of elasticity of the endothelium.

Important! One of the main functions of the endothelial membrane of the vessel is to provide stable resistance to changing blood pressure. That is, the stretching of the vessel with an increase in the volume of blood flow (diastole) and the acquisition of initial parameters with a decrease in volume (sitol). Loss of elasticity of the vascular wall due to atherosclerosis, accompanied by calcification of sclerotic plaques, leads to the development of hypertension, which, in turn, is the direct cause of arterial distension.

Cost of duplex sonography

The cost of the procedure depends on the condition of the equipment, the prestige of the clinic in which it will be conducted and the specialist who makes the diagnosis based on the study. The minimum price for USDG is 500 rubles. The maximum is up to 5000 (prices in Moscow average 2500 rubles).

The price of color and conventional duplex scanning of the BCA varies in the range of 1700-4000 rubles. Complex ultrasound examination of the vessels of the neck and head (brachiocephalic cerebral vertebral arteries) costs an average of 6000 rubles. Ultrasonography is done free of charge by the doctor, or the insurance company reimburses the costs if the person has an OMS policy.

Comment on the information and write about the personal experience of the BCA examination, share the article on social networks. All the best.

Where can I make BCA Doppler ultrasound?

To undergo this examination, you need to contact your local GP. He will tell you which clinic in your city is available. If you wish, you can contact private clinics. There, the procedure is carried out without queue for an individual recording.

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Tatyana Jakowenko

Editor-in-chief of the Detonic online magazine, cardiologist Yakovenko-Plahotnaya Tatyana. Author of more than 950 scientific articles, including in foreign medical journals. He has been working as a cardiologist in a clinical hospital for over 12 years. He owns modern methods of diagnosis and treatment of cardiovascular diseases and implements them in his professional activities. For example, it uses methods of resuscitation of the heart, decoding of ECG, functional tests, cyclic ergometry and knows echocardiography very well.

For 10 years, she has been an active participant in numerous medical symposia and workshops for doctors - families, therapists and cardiologists. He has many publications on a healthy lifestyle, diagnosis and treatment of heart and vascular diseases.

He regularly monitors new publications of European and American cardiology journals, writes scientific articles, prepares reports at scientific conferences and participates in European cardiology congresses.

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