Operative Procedures for Ultrasound Assessment of Extracranial Artery Disease: A Narrative Review by the Italian Society for Vascular Investigation (SIDV)

Background: Duplex ultrasonography (DUS) of the extracranial arteries is essential for the primary and secondary prevention of ischemic stroke and the diagnosis of other cerebrovascular pathologies. The aim of the Italian Society for Vascular Investigation (SIDV) is to provide a standardised approach for the ultrasound evaluation of extracranial arterial disease. Methods: A multidisciplinary SIDV expert panel conducted a comprehensive literature search and performed a narrative review of the recent medical literature; the updated operative procedures were subsequently developed through a consensus-driven process that included dedicated meetings and national congress sessions for discussion and validation. Results: This document outlines a comprehensive approach to the ultrasound evaluation of extracranial arteries, detailing techniques such as Brightness Mode (B-mode), Colour Doppler, Power Doppler, contrast-enhanced ultrasound (CEUS), micro-vascular flow imaging (MVFI), and Three-Dimensional (3D) ultrasound. The text provides an in-depth discussion of clinical indications, technical protocols, plaque characterisation, stenosis quantification, and hemodynamic criteria. Emerging technologies are also examined for their potential to improve cerebrovascular risk stratification. Conclusions: The updated SIDV operative procedures for the ultrasound evaluation of extracranial cerebrovascular disease are intended to serve as a valuable reference for clinicians and vascular laboratories.