1. Carotid duplex ultrasound
Jenelle Beadle
March, 2015

2. indications Cerebrovascular Accident (CVA)
Transient Ischemic Attacks (TIA)
Cervical Bruit
Pulsatile Mass
Less Specific Symptoms
Dizziness
Headaches
Pre-operative
Post-operative
Monitor known carotid arterial disease

3. Position/technique Patient Position Supine Head angled to the side
Rolled towel under neck
Position adjusted to optimize sonographic window

4. Position/technique Patient Position Supine Head angled to the side
Rolled towel under neck
Position adjusted to optimize sonographic window
Technique
Highest frequency, penetrating transducer
Keep angle at 60 degrees
Diagnostic Criteria
Reproducibility
3-5 cycles/waveform
Waveform 2/3 of image
Lower baseline
Decrease scale

5. Exam protocol Protocol will be available on Sharepoint
Written and Image formats
Protocol still needs to be approved to be made official

6. Exam protocol Protocol will be available on Sharepoint
Written and Image formats
Protocol still needs to be approved to be made official
Scan Assistant protocol has been set up in accordance with written protocol
Protocol will also be set up on Siemens machine at SH

7. Exam protocol Protocol will be available on Sharepoint
Written and Image formats
Protocol still needs to be approved to be made official
Scan Assistant protocol has been set up in accordance with written protocol
Protocol will also be set up on Siemens machine at SH
Examine all accessible portions of the CCA/ICA
Basic assessment of the ECA/Vert/Subcl

8. Exam protocol Protocol will be available on Sharepoint
Written and Image formats
Protocol still needs to be approved to be made official
Scan Assistant protocol has been set up in accordance with written protocol
Protocol will also be set up on Siemens machine at SH
Examine all accessible portions of the CCA/ICA
Basic assessment of the ECA/Vert/Subcl
Protocol is designed to be the minimal required images
Additional images will often be necessary when the exam is normal
Additional images will always be necessary when pathology is encountered

9. *Image at the most proximal, straight segment
CCA Proximal
Trans

10. CCA Proximal
Long

11. CCA Proximal
Color Doppler

12. CCA Proximal
Spectral Doppler

13. *2-3cm below the bifurcation
CCA Distal
Trans
Transducer: 6-15MHz

14. CCA Distal
Long

15. CCA Distal
Color Doppler

16. CCA Distal
Spectral Doppler

17. CCA Spectral Analysis:
EDV should be above zero
EDV should be similar to the contralateral CCA, taken at approximately the same level

18. Bifurcation
Trans (bulb)

19. Bifurcation
Trans (just above bulb)

20. *Look for branches
ECA Prox
Long

21. ECA Prox
Color Doppler

22. ECA Prox
Spectral Doppler

23. ECA Spectral Analysis
Higher resistance than the ICA
PSV normally greater ICA
Sharp upstroke
Prominent dicrotic notch (may reverse)
EDV approach/reach zero

24. *Include bulb
ICA Prox
Long

25. *Obtained just below the bulb where vessel is no longer dilated
ICA Prox
Color Doppler

26. *Waveform may reflect flow disturbances of the bulb extending into the prox ICA
ICA Prox
Spectral Doppler

27. ICA Mid
Color Doppler

28. ICA Mid
Spectral Doppler

29. ICA Dist
Color Doppler

30. ICA Dist
Spectral Doppler

31. ICA Spectral Analysis
Low resistance
Continuous forward flow
EDV well above zero

32. Vertebral
Color Doppler

33. Vertebral
Spectral Doppler

34. Vertebral Spectral Analysis
Low resistance
Slightly more resistive than the ICA
Antegrade, bidirectional, retrograde

35. *Sampled close to the origin
Subclavian
Color Doppler

36. Subclavian
Spectral Doppler

37. Subclavian Spectral Analysis
High resistance
Reversal late systole/early diastole

38. Repeat on left

39. Online form
PSV
EDV
PSV

40. Tips/tricks

41. Long ECA/ICA
Two for the price of one
Satisfies the Long ICA & Long ECA B-mode requirements; do not have to do x2 separate images

42. Long ECA/ICA
Two for the price of one
Satisfies the Long ICA & Long ECA B-mode requirements; do not have to do x2 separate images

43. Branches = ECA

44. Tap on superficial temporal artery ant/sup to ear Indicates ECA
Temporal Tap
Tap on superficial temporal artery
ant/sup to ear
Indicates ECA
Not reliable

45. Even w/ normal pts, you can get a + temp tap in the ICA
In pt’s w/ a significant stenosis of the ECA, results of temp tap may be - in ECA & + in ICA

46. Bulb
“ICA Prox”
Widened portion of the proximal ICA
Disturbed flow
Unidirectional along the flow divider of the birfurcation
Zero/reversed flow at outer wall

47. Vertebral Origin
Most common location for stenoses

48. Not required unless pathology is suspected
CCA
Subclav
Innominate
Not required unless pathology is suspected

49. Innominate
Not required unless pathology is suspected

50. Image quality Distal ICA can be difficult to demonstrate
Prox/Mid ICA Doppler settings are not adequate to optimize the distal ICA
adjustments must be made

51. Lowered Color Frequency

52. Increase Color Gain

53. Decreased Steer Box Angle

54. By making x3 adjustments
After
Before