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Color Duplex Scanning of the Extracranial Carotid Arteries

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Noninvasive Vascular Diagnosis

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Abstract

A complete carotid duplex examination should include the peak systolic and end diastolic velocities of common, internal, and external carotid arteries, right and left subclavian arteries, and vertebral arteries; the internal carotid to common carotid artery peak systolic velocities ratio; flow direction of the vertebral artery (antegrade or retrograde); analysis of the Doppler spectral waveform of the examined vessels; and the presence or absence of plaque and description of its morphology.

A carotid duplex ultrasound examination should be termed “inconclusive” if the findings are uncertain, and it cannot be ensured that the carotid artery does not have significant carotid artery disease. Calcification and shadowing, high bifurcation, short neck, or any other circumstances that prevent adequate interrogation of the carotid artery can result in an inconclusive examination. In this scenario, other diagnostic modalities must be recommended to delineate the proper pathology.

The accuracy of duplex scanning in the examination of the carotid artery bifurcation has resulted in its use for detecting significant carotid stenosis in symptomatic patients, the evaluation of patients with neck bruits, postoperative imaging of endarterectomized vessels, and follow-up of asymptomatic patients to document progression of disease. Other clinical implications include carotid endarterectomy based on duplex ultrasound without angiography, intraoperative assessment of carotid endarterectomy, long-term follow-up after carotid endarterectomy, plaque morphology and outcome, and carotid duplex scanning following trauma.

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Author information

Authors and Affiliations

  1. Department of Surgery, Division of Vascular/Endovascular Surgery, West Virginia University/Charleston Division, 3110 MacCorkle Ave., SE, Charleston, WV, 25304, USA

    Ali F. AbuRahma MD

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  1. Ali F. AbuRahma MD
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Correspondence to Ali F. AbuRahma MD .

Editor information

Editors and Affiliations

  1. Charleston, West Virginia, USA

    Ali F. AbuRahma

Review Questions

Review Questions

  1. 1.

    The term “duplex ultrasound” describes:

    1. a.

      The use of B-mode imaging to examine a blood vessel

    2. b.

      The use of a continuous-wave Doppler to examine a blood vessel

    3. c.

      The use of a pulsed Doppler to examine a blood vessel

    4. d.

      A combination of B-mode imaging and Doppler component to examine the flow in a blood vessel

  2. 2.

    In estimating the severity of carotid stenosis, the following are indicative of ≥70–99% internal carotid artery stenosis:

    1. a.

      PSV of 225 cm/s with an EDV of 50 cm/s

    2. b.

      PSV of 220 cm/s with an EDV of 75 cm/s

    3. c.

      PSV of 150 cm/s with an EDV of 85 cm/s

    4. d.

      PSV of >230 cm/s with an EDV of 100 cm/s

  3. 3.

    According to the carotid consensus criteria, the following velocities are suggestive of internal carotid artery stenosis of 50–<70%:

    1. a.

      PSV of 180 cm/s with an EDV of 60 cm/s

    2. b.

      PSV of 120 cm/s with an EDV of 50 cm/s

    3. c.

      PSV of 230 cm/s with an EDV of 100 cm/s

    4. d.

      PSV of 122 cm/s with an EDV of 30 cm/s

  4. 4.

    According to the carotid consensus criteria, the following velocities are suggestive of internal carotid artery stenosis of <50%:

    1. a.

      PSV of 150 cm/s with an EDV of 30 cm/s and an ICA/CCA ratio of 1.5

    2. b.

      PSV of 130 cm/s with an EDV of 40 cm/s and an ICA/CCA ratio of 1.5

    3. c.

      PSV of 125 cm/s with an EDV <40 cm/s and an ICA/CCA ratio of <2

    4. d.

      PSV of 100 cm/s and an EDV of <40 cm/s and an ICA/CCA ratio of <2

Answer Key

  1. 1.

    d

  2. 2.

    d

  3. 3.

    a

  4. 4.

    c

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AbuRahma, A.F. (2017). Color Duplex Scanning of the Extracranial Carotid Arteries. In: AbuRahma, A. (eds) Noninvasive Vascular Diagnosis. Springer, Cham. https://doi.org/10.1007/978-3-319-54760-2_7

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  • DOI: https://doi.org/10.1007/978-3-319-54760-2_7

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