Abstract
A complete extracranial carotid duplex examination should include the following data: the peak systolic and end-diastolic velocities of common carotid, internal carotid, and external carotid arteries, right and left subclavian arteries, and vertebral arteries; the internal carotid artery to common carotid artery peak systolic velocity 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 the sequential examination 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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Kossoff G. Gray scale echography in obstetrics and gynecology. Report no. 60. Sydney: Commonwealth Acoustic Laboratories; 1973.
Olinger CP. Ultrasonic carotid echoarteriography. Am J Roentgenol. 1969;106:282–95.
Hartley DJ, Strandness Jr DE. The effects of atherosclerosis on the transmission of ultrasound. J Surg Res. 1969;9:575–82.
Barber FE, Baker DW, Nation AWC, et al. Ultrasonic duplex echo-Doppler scanner. IEEE Trans Biomed Eng. 1974;81:109–13.
Blackshear WM, Phillips DJ, Chikos RM, et al. Carotid artery velocity patterns in normal and stenotic vessels. Stroke. 1980;11:67–71.
Reilly LM. Importance of carotid plaque morphology. In: Bernstein EF, editor. Vascular diagnosis. 4th ed. St. Louis: Mosby-Year Book; 1993. p. 333–40.
AbuRahma AF, Kyer PR, Robinson P, et al. The correlation of ultrasonic carotid plaque morphology and carotid plaque hemorrhage: clinical implications. Surgery. 1998;124:721–6.
AbuRahma AF, Thiele S, Wulu J. Prospective controlled study of the natural history of asymptomatic 60% to 69% carotid stenosis according to ultrasonic plaque morphology. J Vasc Surg. 2002;36:437–42.
Gronholdt M, Nordestgaard B, Schroeder T, et al. Ultrasonic echolucent carotid plaques predict future strokes. Circulation. 2001;104:68–73.
Thiele BL, Hutchison KJ, Green RM, et al. Pulsed Doppler waveform patterns produced by smooth stenosis in the dog thoracic aorta. In: Taylor DEM, editor. Blood flow theory and practice. New York: Academic Press; 1983. p. 85–104.
Zierler RE, Strandness Jr DE. Noninvasive dynamic and real-time assessment of extracranial cerebrovasculature. In: Wood JH, editor. Cerebral blood flow: physiologic and clinical aspects. New York: McGraw-Hill; 1987. p. 311–23.
Bodily KC, Phillips DJ, Thiele BL, et al. Noninvasive detection of internal carotid artery occlusion. Angiology. 1981;32:517–21.
AbuRahma AF, Jarrett K, Hayes JD. Clinical implications of power Doppler three-dimensional ultrasonography. Vascular. 2004;12:293–300.
Zwiebel WJ. New Doppler parameters for carotid stenosis. Semin Ultrasound CT MR. 1997;18:66–71.
AbuRahma AF, Robinson PA, Stickler DL, et al. Proposed new duplex classification for threshold stenoses used in various symptomatic and asymptomatic carotid endarterectomy trials. Ann Vasc Surg. 1998;12:349–58.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325:445–53.
Asymptomatic Carotid Atherosclerosis Study Group. Study design for randomized prospective trial of carotid endarterectomy for asymptomatic atherosclerosis. Stroke. 1989;20:844–9.
Faught WE, Mattos MA, van Bemmelen PS, et al. Color-flow duplex scanning of carotid arteries: new velocity criteria based on receiver operator characteristic analysis for threshold stenoses used in the symptomatic and asymptomatic carotid trials. J Vasc Surg. 1994;19:818–28.
Neale ML, Chambers JL, Kelly AT, et al. Reappraisal of duplex criteria to assess significant carotid stenosis with special reference to reports from the North American symptomatic carotid endarterectomy trial and the European carotid surgery trial. J Vasc Surg. 1994;20:642–9.
Moneta GL, Edwards JM, Chitwood RW, et al. Correlation of North American symptomatic carotid endarterectomy trial (NASCET) angiographic definition of 70% to 99% internal carotid artery stenosis with duplex scanning. J Vasc Surg. 1993;17:152–9.
Hood DB, Mattos MA, Mansour A, et al. Prospective evaluation of new duplex criteria to identify 70% internal carotid artery stenosis. J Vasc Surg. 1996;23:254–62.
Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA. 1995;273:1421–8.
Moneta GL, Edwards JM, Papanicolaou G, et al. Screening for asymptomatic internal carotid artery stenosis: duplex criteria for discriminating 60% to 99% stenosis. J Vasc Surg. 1995;21:989–94.
Carpenter JP, Lexa FJ, Davis JT. Determination of sixty percent or greater carotid artery stenosis by duplex Doppler ultrasonography. J Vasc Surg. 1995;22:697–705.
Burnham CB, Liguish Jr J, Burnham SJ. Velocity criteria redefined for the 60% carotid stenosis. J Vasc Technol. 1996;20(1):5–11.
AbuRahma AF, Pollack JA, Robinson PA, et al. New duplex criteria for threshold stenoses used in the asymptomatic carotid atherosclerosis study (ACAS). Vasc Surg. 1999;33:23–32.
Marshall Jr WG, Kouchoukos NT, Murphy SF, et al. Carotid endarterectomy based on duplex scanning without preoperative arteriography. Circulation. 1988;78(Suppl I):I1–5.
Geuder JW, Lamparello PJ, Riles TS, et al. Is duplex scanning sufficient evaluation before carotid endarterectomy? J Vasc Surg. 1989;9:193–201.
AbuRahma AF, Robinson PA, Boland JP, et al. Complications of arteriography in a recent series of 707 cases: factors affecting outcome. Ann Vasc Surg. 1993;7:122–9.
Haynes B, Thorpe K, Raylor W, et al. Poor performance of ultrasound in detecting high-grade carotid stenosis (abstract). Can J Surg. 1992;35:446.
Daigle RJ, Stavros AT, Lee RM. Overestimation of velocity and frequency values by multi-element linear array Dopplers. J Vasc Technol. 1990;14:206–13.
Patel MR, Kuntz KM, Klufas RA, et al. Preoperative assessment of the carotid bifurcation: can magnetic resonance angiography and duplex ultrasonography replace contrast arteriography? Stroke. 1995;26:1753–8.
Huston J, Nichols DA, Luetmer PH, et al. MR angiographic and sonographic indications for endarterectomy. AJNR Am J Neuroradiol. 1998;19:309–15.
Belsky M, Gaitini D, Goldsher D, et al. Color-coded duplex ultrasound compared to CT angiography for detection and quantification of carotid artery stenosis. Eur J Ultrasound. 2000;12:49–60.
Anderson GB, Ashforth R, Steinke DE, et al. CT angiography for the detection and characterization of carotid artery bifurcation disease. Stroke. 2000;31:2168–74.
Back MR, Wilson JS, Rushing G, et al. Magnetic resonance angiography is an accurate imaging adjunct to duplex ultrasound scan in patient selection for carotid endarterectomy. J Vasc Surg. 2000;32:429–40.
Johnston DC, Goldstein LB. Clinical carotid endarterectomy decision-making. Neurology. 2001;56:1009–15.
Nederkoorn PJ, Mali WP, Eikelboom BC, et al. Preoperative diagnosis of carotid artery stenosis: accuracy of noninvasive testing. Stroke. 2002;33:2003–8.
MacKenzie KS, French-Sherry E, Burns K, et al. B-mode ultrasound measurement of carotid bifurcation stenoses: is it reliable? Vasc Endovasc Surg. 2002;36:123–35.
Serfaty JM, Chirossel P, Chevallier JM, Ecochard R, Froment JC, Douek PC. Accuracy of three-dimensional gadolinium-enhanced MR angiography in the assessment of extracranial carotid artery disease. AJR Am J Roentgenol. 2000;175:455–63.
White JE, Russell WL, Grer MS, Whittle MT. Efficacy of screening MR angiography and Doppler ultrasonography in the evaluation of carotid artery stenosis. Am Surg. 1994;60:340–8.
Turnipseed WD, Kennell TW, Turski PA, Acher CW, Hock JR. Combined use of duplex imaging and magnetic resonance angiography for evaluation of patients with symptomatic ipsilateral high-grade carotid stenosis. J Vasc Surg. 1993;17:832–9.
Riles TS, Eidelman EM, Litt AW, Pinto RS, Oldford F, Schwartzenberg GW. Comparison of magnetic resonance angiography, conventional angiography, and duplex scanning. Stroke. 1992;23:341–6.
Johnson MB, Wilkinson ID, Wattam J, Venables GS, Griffiths PD. Comparison of Doppler ultrasound, magnetic resonance angiographic techniques and catheter angiography in evaluation of carotid stenosis. Clin Radiol. 2000;55:912–20.
Link J, Brossmann J, Penselin V, Gluer CC, Heller M. Common carotid artery bifurcation: preliminary results of CT angiography and color-coded duplex sonography compared with digital subtraction angiography. AJR Am J Roentgenol. 1997;168:361–5.
Bray JM, Galland F, Lhoste P. Colour Doppler and duplex sonography and angiography of the carotid artery bifurcations. Prospective, double-blind study. Neuroradiology. 1995;37:219–24.
Bluth EI, Sunshinte JH, Lyons JB, et al. Power Doppler imaging: initial evaluation as a screening examination for carotid artery stenosis. Radiology. 2000;215:791–800.
Jackson MR, Chang AS, Robles HA, et al. Determination of 60% or greater carotid stenosis: a prospective comparison of magnetic resonance angiography and duplex ultrasound with conventional angiography. Ann Vasc Surg. 1998;12:236–43.
Walters GK, Jones CE, Meyd CJ, Cavaluzzi JA, Chachich BM. The role of carotid duplex ultrasonography in the therapeutic algorithm of extracranial carotid disease. J Vasc Technol. 1993;17:177–82.
Wardlaw JM, Chappell FM, Stevenson M, et al. Accurate, practical and cost-effective assessment of carotid stenosis in the UK. Health Technol Assess. 2006;10:iii–iv, ix–x, 1–182, Review.
Grant EG, Benson CB, Moneta GL, Alexandrov AV, Baker JD, Bluth EI, Carroll BA, Eliasziw M, Gocke J, Hertzberg BS, Katarick S, Needleman L, Pellerito J, Polak JF, Rholl KS, Wooster DL, Zierler E. Carotid artery stenosis: grayscale and Doppler ultrasound diagnosis – society of radiologists in ultrasound consensus conference. Ultrasound Q. 2003;19:190–8.
AbuRahma AF, Srivastava M, Stone PA, Mousa AY, Jain A, Dean LS, Keiffer T, Emmett M. Critical appraisal of the carotid duplex consensus criteria in the diagnosis of carotid artery stenosis. J Vasc Surg. 2011;53:53–60.
AbuRahma AF, Richmond BK, Robinson PA, et al. Effect of contralateral severe stenosis or carotid occlusion on duplex criteria of ipsilateral stenoses: comparative study of various duplex parameters. J Vasc Surg. 1995;22:751–62.
Spadone DP, Barkmeier LD, Hodgson KJ, et al. Contralateral internal carotid artery stenosis or occlusion: pitfall of correct ipsilateral classification. A study performed with color flow imaging. J Vasc Surg. 1990;11:642–9.
Forconi S, Johnston KW. Effect of contralateral internal carotid stenosis on the accuracy of continuous wave Doppler spectral analysis results. J Cardiovasc Surg. 1987;28:715–8.
Hayes AC, Johnston KW, Baker WH, et al. The effect of contralateral disease on carotid Doppler frequency. Surgery. 1988;103:19–23.
Beckett Jr WW, Davis PC, Hoffman Jr JC. Duplex Doppler sonography of the carotid artery: false positive results in an artery contralateral to an artery with marked stenosis. AJR Am J Roentgenol. 1990;155:1091–5.
Fujitani RM, Mills JL, Wang LM, et al. The effect of unilateral internal carotid arterial occlusion upon contralateral duplex study: criteria for accurate interpretation. J Vasc Surg. 1992;16:459–68.
Fisher M, Alexander K. Influence of contralateral obstructions on Doppler-frequency spectral analysis of ipsilateral stenoses of the carotid arteries. Stroke. 1985;16:846–8.
Bluth EI, Stavros AT, Marich KW, et al. Carotid duplex sonography: a multicenter recommendation for standardized imaging and Doppler criteria. Radiographics. 1988;8:487–506.
AbuRahma AF, Richmond BK, Robinson PA, Khan S, Pollack JA, Alberts S. Effect of contralateral severe stenosis or carotid occlusion on duplex criteria of ipsilateral stenoses: comparative study of various duplex parameters. J Vasc Surg. 1995;22:751–61.
Wyman RA, Mays ME, McBride PE, Stein JH. Ultrasound-detected carotid plaque as a predictor of cardiovascular events. Vasc Med. 2006;11:123–30.
Culebras A, Kase CS, Masdeu JC, et al. Practice guidelines for the use of imaging in transient ischemic attacks and acute stroke. A report of the Stroke Council, American Heart Association. Stroke. 1997;28:1480–97.
Lovelace TD, Moneta GL, Abou-Zamzam Jr AM, Edwards JM, Yeager RA, Landry GJ, Taylor Jr LM, Porter JM. Optimizing duplex follow-up in patients with an asymptomatic internal carotid artery stenosis of less than 60%. J Vasc Surg. 2001;33:56–61.
Lavensen GS. The carotid artery ultrasound reports: considerations in evaluation and management. J Vasc Ultrasound. 2004;28:15–9.
Roederer GO, Langlois MD, Jager MD, et al. The natural history of carotid arterial disease in asymptomatic patients with cervical bruits. Stroke. 1984;15:605–13.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag London
About this chapter
Cite this chapter
AbuRahma, A.F. (2013). Duplex Scanning of the Extracranial Carotid Arteries. In: AbuRahma, A., Bandyk, D. (eds) Noninvasive Vascular Diagnosis. Springer, London. https://doi.org/10.1007/978-1-4471-4005-4_7
Download citation
DOI: https://doi.org/10.1007/978-1-4471-4005-4_7
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-4004-7
Online ISBN: 978-1-4471-4005-4
eBook Packages: MedicineMedicine (R0)