The Carotid Artery Ultrasound Report: Considerations in Evaluation and Management

Introduction Color duplex ultrasound (CDU) is the best means of discovering the significant, silent carotid artery lesions that are the leading cause of strokes. CDU reports routinely include flow velocity and derived percent degree of stenosis. However, failure to include inadequacies and inconsistencies of the examination coupled with knowledge of interpretation variances correlated with the clinical situation can lead to significant carotid lesions going undiscovered and leave proper management uncertain. Methods The author is a vascular surgeon and registered vascular technologist who specializes in the evaluation and management of carotid artery disease with opportunity to perform CDU, orchestrate additional tests required, make management recommendations, and correlate these with operative findings and clinical outcome. Results This experience led to the identification of important considerations relating to the CDU examination that recognize the not uncommon need for additional tests and for management recommendations. These considerations were categorized as indeterminate examinations, inconsistent examinations, interpretation variances, and individual clinical situations. Conclusions These considerations highlight the value of including recommendations for needed additional tests and management in the CDU report. Vascular laboratories able to make this more comprehensive report can reduce the chance of serious carotid artery lesions going undetected and better ensure appropriate management of the patient.