Carotid artery stenosis echocardiography or ultrasound

Carotid stenosis is usually diagnosed by ultrasound scan of the neck arteries. This is the first imaging option and usually used for follow up and observation as it involves no radiation and no contrast agents that may cause allergic reactions.

• Carotid duplex ultrasound is the test of choice to evaluate carotid disease.
• Grading:
  • Mild – < 40% stenosis
  • Moderate – 40 – 69% stenosis
  • Severe – 70 – 99% stenosis

• Normal:
  • ICA PSV is less than 125 cm/sec and no plaque or intimal thickening is visible sonographically.
  • Additional criteria include ICA/CCA PSV ratio < 2.0 and ICA EDV < 40 cm/sec.
• <50% ICA stenosis:
  • ICA PSV is less than 125 cm/sec and plaque or intimal thickening is visible sonographically.
  • Additional criteria include ICA/CCA PSV ratio < 2.0 and ICA EDV < 40 cm/sec.
• 50%–69% ICA stenosis:
  • ICA PSV is 125–230 cm/sec and plaque is visible sonographically.
  • Additional criteria include ICA/CCA PSV ratio of 2.0–4.0 and ICA EDV of 40–100 cm/sec.
• >=70% ICA stenosis but less than near occlusion
  • ICA PSV is greater than 230 cm/sec and visible plaque and luminal narrowing are seen at gray-scale and color Doppler US (The higher the Doppler parameter lies above the threshold of 230 cm/sec, the greater the likelihood of severe disease).
  • Additional criteria include ICA/CCA PSV ratio > 4 and ICA EDV > 100 cm/sec.
• Vear occlusion of the ICA:
  • Velocity parameters may not apply, since velocities may be high, low, or undetectable.
  • Diagnosis is established primarily by demonstrating a markedly narrowed lumen at color or power Doppler US (35).
• Total occlusion of the ICA
  • No detectable patent lumen at gray-scale US and no flow with spectral, power, and color Doppler US. ^[1]

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