A carotid ultrasound report can contain unfamiliar terms such as stenosis, plaque, PSV, EDV, and ICA. Although the language may sound technical, the purpose of the examination is straightforward: to determine whether the arteries supplying blood to your brain are narrowed and, if so, how significant that narrowing may be.
Understanding the basic terminology can help you have a more informed conversation with your vascular surgeon about your results, stroke risk, and recommended next steps.
The carotid arteries are major blood vessels located on each side of your neck. They carry oxygen-rich blood to your brain.
Carotid artery stenosis means that one of these arteries has become narrowed. The most common cause is atherosclerosis, which is the buildup of plaque inside the artery wall. Plaque may contain cholesterol, calcium, fat, and other materials.
As plaque accumulates, it can:
When blood flow to part of the brain is interrupted, it can cause a transient ischemic attack, commonly called a TIA or “mini-stroke,” or a stroke.
A carotid ultrasound, also known as a carotid duplex examination, is a painless, noninvasive test. No needles, radiation, or contrast dye are required.
During the examination, a registered vascular technologist places a small handheld device called a transducer against the skin of your neck. The examination combines two types of ultrasound information:
The test usually evaluates both sides of the neck. The technologist may ask you to turn your head slightly so the arteries can be examined from several angles.
Stenosis means narrowing. A report may describe stenosis using a percentage or a general category such as mild, moderate, or severe.
The percentage estimates how much the inside diameter of the artery has narrowed. For example, 50% stenosis means that the artery is estimated to be narrowed by approximately half at that location. It does not mean that blood flow has been reduced by exactly 50%.
Plaque is material that has accumulated within the artery wall. An ultrasound report may describe its location, amount, surface, or appearance.
You may see terms such as:
The presence of plaque indicates atherosclerotic disease, even when the resulting narrowing is not severe. It may signal the need to address cardiovascular risk factors such as smoking, high blood pressure, high cholesterol, and diabetes.
ICA stands for internal carotid artery. This is the branch of the carotid artery that carries blood toward the brain. Because narrowing in the ICA can affect the brain’s blood supply, it is a major focus of the examination.
CCA stands for common carotid artery. The common carotid artery travels up the neck before dividing into the internal and external carotid arteries.
Your report may include an ICA/CCA ratio, which compares blood-flow velocity in the internal carotid artery with velocity in the common carotid artery. This comparison helps the interpreting physician assess the severity of a narrowing.
ECA stands for external carotid artery. It primarily supplies blood to the face, scalp, and other structures outside the brain.
PSV means peak systolic velocity. It is the fastest blood-flow speed measured during the part of the heartbeat when the heart contracts.
Blood generally moves faster as it passes through a narrowed section of an artery, similar to water moving more quickly through a narrowed opening. A higher PSV can therefore be an important sign of stenosis.
However, PSV is not interpreted by itself. The physician also considers the artery’s appearance, the amount of plaque, other velocity measurements, and the overall blood-flow pattern.
EDV means end-diastolic velocity. It measures blood-flow speed when the heart is between contractions.
EDV can provide additional information about the severity of a narrowing, particularly when stenosis is more advanced. As with PSV, it is considered alongside several other findings.
Bilateral means both sides. “Bilateral carotid plaque,” for example, means plaque was identified in carotid arteries on both the right and left sides.
Bilateral disease does not necessarily mean the narrowing is equal on both sides. One artery may have minimal plaque while the other has a more significant stenosis.
An occlusion means the artery appears to be completely blocked. This is different from severe stenosis, in which a small channel of blood flow remains.
A suspected occlusion may require additional evaluation to confirm the finding and determine the appropriate treatment plan.
Carotid stenosis is commonly grouped into general categories:
|
Report wording |
General meaning |
|
Normal or no significant stenosis |
No meaningful narrowing is detected |
|
Less than 50% stenosis |
Minimal or mild narrowing |
|
50%–69% stenosis |
Moderate narrowing |
|
70% or greater stenosis |
Severe narrowing |
|
Near-occlusion |
The artery is critically narrowed, with only limited flow remaining |
|
Occlusion |
The artery appears completely blocked |
These categories are based on a combination of visible plaque, PSV, EDV, the ICA/CCA velocity ratio, and other ultrasound findings. Current interpretation criteria may vary somewhat among vascular laboratories, so an individual velocity value should not be used to interpret a report without the complete study.
In 2023, IAC Vascular Testing issued updated recommendations intended to improve standardization and accuracy in grading internal carotid artery stenosis. This is one reason it is important to have carotid testing performed and interpreted by an experienced vascular laboratory using validated criteria. IAC Vascular Testing
No. Finding carotid plaque or stenosis does not automatically mean that surgery or another procedure is necessary.
For many people with mild or moderate asymptomatic stenosis, the standard approach may include:
Surveillance allows your vascular surgeon to determine whether the narrowing is stable or progressing. The recommended interval depends on the severity of the disease, previous results, symptoms, and overall medical history.
Intervention may be considered when stenosis is more severe or when a patient has experienced symptoms consistent with a TIA or stroke. Treatment options can include carotid endarterectomy in which plaque is surgically removed, a carotid stenting procedure or a transcarotid artery revascularization (TCAR) procedure in selected patients .
The Society for Vascular Surgery recommends considering carotid endarterectomy for certain patients with significant stenosis, but the decision depends on whether the patient has symptoms, the degree of narrowing, procedural risk, life expectancy, anatomy, and other health factors. Society for Vascular Surgery guidelines
The same percentage of stenosis may be managed differently depending on whether the patient has experienced neurological symptoms.
Possible warning signs of a TIA or stroke include:
These symptoms require immediate medical attention. Call 911, even if the symptoms disappear after a few minutes. A TIA can be an important warning sign of a future stroke.
A carotid ultrasound provides valuable information, but treatment decisions should not be based on one number in the report. Your vascular surgeon will consider:
In some cases, a CT angiogram, MR angiogram, or another imaging study may be recommended to clarify the anatomy or help plan treatment.
The Vein Institute of NJ at The Cardiovascular Care Group has extensive experience diagnosing, monitoring, and treating carotid artery disease. Our noninvasive vascular laboratories use detailed imaging and blood-flow measurements to evaluate carotid stenosis and help determine whether medical management, ultrasound surveillance, or intervention is appropriate.
If your report mentions carotid plaque, elevated velocities, or stenosis, a vascular surgeon can explain what those findings mean for you and recommend an individualized plan to help reduce your risk of stroke.
This article is intended for general educational purposes and should not replace an evaluation or treatment recommendation from your healthcare provider.