RadteraCarotid Duplex Ultrasound
USNo contrastVascular
Indications
- Carotid bruit
- TIA / stroke / amaurosis fugax
- Follow-up of known carotid stenosis
- Pre-operative vascular evaluation
- Pulsatile neck mass
Patient prep
- None
- Supine with head slightly extended and turned away from side examined
Contrast
None / non-contrast
Technique
- Linear transducer 5-7+ MHz (lower frequency for deep vessels)
- Grayscale of CCA, bulb, ICA, ECA; characterize plaque
- Color Doppler to identify flow and stenotic jets
- Spectral Doppler with angle correction <=60 degrees parallel to flow at multiple levels
Series / Sequences
| # | Series / Sequence | Plane | Notes |
|---|---|---|---|
| 1 | Proximal/mid/distal CCA - grayscale | Long and transverse | Plaque, IMT |
| 2 | Carotid bulb | Long axis | Plaque characterization |
| 3 | ICA proximal/mid/distal | Long axis | Plaque; narrowest point for PSV |
| 4 | ECA | Long axis | Identify by branches/temporal tap |
| 5 | Spectral Doppler PSV/EDV - CCA, ICA, ECA bilaterally | Spectral | Record ICA PSV, EDV, and ICA/CCA PSV ratio |
| 6 | Vertebral artery | Long axis with spectral | Flow direction (antegrade vs retrograde for subclavian steal) |
Key points
- Grade ICA stenosis by SRU consensus criteria: Normal <125 cm/s no plaque; <50% <125 cm/s with plaque; 50-69% PSV 125-230 cm/s; >=70% PSV >230 cm/s with plaque
- Secondary criteria for >=70%: ICA/CCA PSV ratio >4 and ICA EDV >100 cm/s
- Maintain Doppler angle <=60 degrees parallel to vessel wall
- Document vertebral artery flow direction; report total occlusion when no patent lumen/flow
Source: Researched — verify against your institution
‹ PreviousMRA Neck (Carotid/Vertebral) With and Without ContrastNext ›Lower Extremity Arterial Duplex
Reference template — verify and adapt to your scanner, vendor and institution before clinical use. Not a substitute for clinical judgment.