Assessment of carotid system

Ultrasound assessment of carotid system, using grayscale imaging, Doppler spectral analysis, and colour Doppler imaging, constitutes an important element of the diagnostic workup, especially in cerebrovascular disease patients. The evaluation of the Carotid system allows a complete and accurate description of the common carotid artery, internal and external carotid artery, site of the bifurcation, presence of atheromatous plaques, measurement of intima‐media thickness and other vessel wall diseases. Transverse and Longitudinal B‐mode imaging scanning provide valuable information about the anatomy of the arterial wall, plaques, arterial patency and the site of the carotid bifurcation. Color mode might help the detection, in some cases, of hypoechoic plaques or fresh blood clots. The analysis of blood flow velocity and direction provides useful hemodynamic information, necessary for an exhaustive assessment of the vessels. The evidence obtained from cerebrovascular ultrasonography is useful for diagnostic as well as prognostic purposes. Although atherosclerosis is the most common disease and object of ultrasound evaluation, other non‐atherosclerotic diseases are of great interest. Arterial wall dissection and its evolution over time; inflammatory arteritis involving neck arteries; identification of a glomus tumor, an arteriovenous fistula or a pseudoaneurysm. Usefulness of ultrasound in acute stroke patients as well as in intensive care unit is mainly due to its use at bedside, non‐invasiveness and repeatability. Furthermore, ultrasound assessment of carotid system can be used to monitor the effect of surgical or endovascular recanalization procedures and to support in decision making for various therapeutic interventions.