Carotid Doppler

Carotid Doppler ultrasound examines the carotid arteries in your neck that supply blood to your brain. This vital scan detects atherosclerotic plaque buildup, arterial narrowing (stenosis), and assesses stroke risk.

It’s a completely non-invasive, painless scan taking 30 minutes, using colour Doppler to visualize blood flow patterns and measure flow velocities. Recommended for people over 60, those with cardiovascular risk factors (diabetes, high cholesterol, smoking, hypertension), or anyone with symptoms like TIAs (mini-strokes), dizziness, or unexplained neurological symptoms.

Our consultant radiologists provide detailed assessment with clear explanation of your cardiovascular health. This scan is crucial for stroke prevention.

Complete Carotid Assessment:

Arteries Examined:

• Common carotid artery (both sides)
• Internal carotid artery (supplies brain)
• External carotid artery (supplies face)
• Carotid bifurcation (common division point)
• Vertebral arteries (back of neck, supplies brain stem)

What We Measure:

• Intima-media thickness (IMT): Early atherosclerosis marker
• Plaque presence and characteristics
• Stenosis percentage (degree of narrowing)
• Peak systolic velocity (PSV): Blood flow speed
• End-diastolic velocity (EDV)
• Velocity ratios (compared to normal)
• Plaque stability (soft vs hard, stable vs unstable)

Who Needs Carotid Doppler:

Age-Related Risk:

• Men over 65
• Women over 70
• Anyone over 60 with additional risk factors

Medical Conditions:

• Previous TIA (transient ischaemic attack/mini-stroke)
• Previous stroke
• Diabetes mellitus
• High cholesterol (hyperlipidaemia)
• Hypertension (high blood pressure)
• Coronary artery disease
• Peripheral arterial disease
• Chronic kidney disease

Symptoms:

• Sudden weakness/numbness in face, arm, or leg
• Temporary vision loss in one eye (amaurosis fugax)
• Difficulty speaking or understanding speech
• Dizziness or loss of balance
• Severe headache
• TIA symptoms (even if resolved)

Risk Factors:

• Current or ex-smoker
• Family history of stroke
• Obesity
• Sedentary lifestyle
• Atrial fibrillation
• Carotid bruit heard by doctor (whooshing sound)

What We Look For:

Atherosclerotic Plaque:

• Soft plaque (vulnerable): Higher rupture risk
• Hard plaque (calcified): More stable but blocks flow
• Mixed plaque
• Ulcerated plaque: Very high risk
• Location: Usually at carotid bifurcation

Stenosis Grading:

• Normal: No significant plaque, <30% narrowing
• Mild stenosis: 30-49% narrowing
• Moderate stenosis: 50-69% narrowing
• Severe stenosis: 70-99% narrowing (high stroke risk)
• Complete occlusion: 100% blocked

Flow Patterns:

• Normal laminar flow
• Turbulent flow (indicates stenosis)
• Reduced velocity (significant narrowing)
• Absent flow (complete blockage)
• Collateral flow patterns

Risk Stratification:

Low Risk:

• No significant plaque
• <50% stenosis
• Normal flow velocities
• Stable plaque characteristics

Moderate Risk:

• 50-69% stenosis
• Moderate plaque burden
• Slightly elevated velocities
• Requires monitoring

High Risk:

• ≥70% stenosis
• Unstable plaque features
• Very high velocities
• Previous neurological symptoms
• May need intervention

Clinical Implications:

If Scan is Normal:

• Reassuring for stroke risk
• Repeat in 3-5 years if risk factors
• Continue preventive medications
• Lifestyle modifications

If Stenosis Detected:

• <50%: Medical management, risk factor control, annual monitoring
• 50-69%: Intensive medical therapy, consider advanced imaging, monitoring
• ≥70% with symptoms: Urgent referral for carotid endarterectomy or stenting
• ≥70% without symptoms: Specialist vascular review

Preventive Actions:

• Antiplatelet therapy (aspirin/clopidogrel)
• Statin therapy (cholesterol lowering)
• Blood pressure control
• Diabetes management
• Smoking cessation
• Lifestyle changes (diet, exercise)

The Scan Process:

• Lie comfortably on examination couch
• Neck extended slightly (pillow support)
• Gel applied to neck
• Both sides examined thoroughly
• Takes 30 minutes
• Completely painless
• Can swallow and talk normally

No Preparation Required:

• No fasting needed
• Wear open-neck clothing
• Continue all medications
• Bring medication list

Immediate Results:

• Discussion after scan
• Detailed written report
• Images of any significant findings
• Clear explanation of stroke risk
• Recommendations for next steps

Monitoring Protocol:

• Normal: Repeat 3-5 years
• Mild stenosis: Annual scans
• Moderate: Regular monitoring
• Severe: Urgent referral, post-treatment monitoring