What is Carotid Ultrasound? Purpose, Levels/Procedure & Results

A carotid ultrasound is a safe, painless test that uses sound waves to create pictures of the blood vessels in your neck. These vessels, called carotid arteries, carry blood from your heart to your brain, making them incredibly important for your health.

Think of it like taking a photograph, but instead of light, doctors use gentle sound waves that bounce off your blood vessels. The test helps your doctor see how well blood flows through these arteries and check for any blockages or narrowing that might affect your brain's blood supply.

What is carotid ultrasound?

Carotid ultrasound is a non-invasive imaging test that examines the carotid arteries in your neck. These two major blood vessels run along both sides of your neck and supply oxygen-rich blood to your brain.

During the test, a technician moves a small device called a transducer over your neck. This device sends out high-frequency sound waves that create real-time images of your arteries on a computer screen. The whole process is completely painless and takes about 30 to 45 minutes.

Your doctor can see the structure of your artery walls, measure blood flow speed, and detect any plaque buildup or narrowing. This information helps assess your risk for stroke and other serious complications.

Why is carotid ultrasound done?

Doctors recommend carotid ultrasound primarily to check for carotid artery disease, which happens when fatty deposits called plaque build up in these vital blood vessels. Early detection can help prevent strokes before they occur.

Your doctor might suggest this test if you have symptoms that could indicate reduced blood flow to your brain. These warning signs deserve attention because they might signal that your arteries are narrowing:

• Sudden weakness or numbness in your face, arm, or leg, especially on one side
• Difficulty speaking or understanding speech
• Sudden vision problems in one or both eyes
• Severe headaches with no known cause
• Dizziness or loss of balance
• Brief episodes of these symptoms that come and go

These tests are also valuable for monitoring people with risk factors for stroke, even when they feel perfectly fine. Regular screening can catch problems early when treatment is most effective.

Sometimes doctors use carotid ultrasound to monitor patients who've already had procedures on their carotid arteries. This helps ensure treatments are working properly and catches any new problems that might develop over time.

What is the procedure for carotid ultrasound?

The carotid ultrasound procedure is straightforward and comfortable. You'll lie on your back on an examination table, and a technician will apply a clear, water-based gel to both sides of your neck.

The gel helps the ultrasound waves travel better between the transducer and your skin. The technician then moves the transducer slowly along your neck, pressing gently to get clear images of your carotid arteries.

Here's what happens during your test, step by step:

1. You'll remove any jewelry around your neck and change into a hospital gown that opens in the front
2. The technician will have you lie down and may place a pillow under your shoulders
3. They'll apply the gel to your neck area
4. The transducer is moved along both sides of your neck to capture images from different angles
5. You might hear whooshing sounds - this is normal and represents your blood flow
6. The technician may ask you to turn your head or hold your breath briefly for clearer pictures

The entire process usually takes 30 to 45 minutes. You can talk normally during the test, and many people find it relaxing. The gel wipes off easily with a towel when the test is complete.

How to prepare for your carotid ultrasound?

One of the best things about carotid ultrasound is that it requires very little preparation. You can eat normally, take your regular medications, and go about your usual activities before the test.

The main thing to remember is wearing comfortable clothing that allows easy access to your neck area. A shirt that buttons in the front or has a loose neckline works perfectly.

You should remove any jewelry around your neck before the test, including necklaces, chokers, or large earrings that might get in the way. If you wear hearing aids, you can keep them in during the procedure.

It's helpful to arrive a few minutes early to complete any necessary paperwork and get settled. Bring a list of your current medications and any previous test results related to your cardiovascular health.

How to read your carotid ultrasound?

Your carotid ultrasound results focus on measuring how much your arteries have narrowed and how fast blood flows through them. The key measurement is the percentage of stenosis, which tells you how much of your artery is blocked.

Normal results typically show less than 50% stenosis, meaning your arteries are relatively clear and blood flows freely. When stenosis reaches 50-69%, doctors consider this moderate narrowing that needs monitoring and lifestyle changes.

Here's how doctors interpret the different levels of artery narrowing:

• Less than 50% stenosis: Normal to mild narrowing, usually managed with lifestyle changes
• 50-69% stenosis: Moderate narrowing that requires medical management and regular monitoring
• 70-99% stenosis: Severe narrowing that often needs surgical intervention
• 100% stenosis: Complete blockage requiring immediate medical attention

Your doctor will also look at blood flow velocities, which tell them how hard your heart has to work to push blood through narrowed areas. Higher velocities often indicate more significant blockages.

The results also describe the characteristics of any plaque found, including whether it's stable or unstable. Unstable plaque poses higher risks because pieces can break off and cause strokes.

How to fix your carotid ultrasound levels?

Improving your carotid ultrasound results depends on the severity of narrowing found and your overall health. For mild to moderate stenosis, lifestyle changes often make a significant difference in slowing or even reversing plaque buildup.

The most effective approach combines healthy lifestyle habits with medical management when needed. Your doctor will work with you to create a plan that fits your specific situation and risk factors.

These lifestyle changes can help improve your artery health over time:

• Following a heart-healthy diet low in saturated fats and high in fruits, vegetables, and whole grains
• Getting regular exercise, even just 30 minutes of walking most days
• Quitting smoking, which significantly reduces plaque buildup
• Managing stress through relaxation techniques or counseling
• Maintaining a healthy weight
• Limiting alcohol consumption

For moderate to severe stenosis, your doctor might prescribe medications like statins to lower cholesterol, blood pressure medications, or blood thinners to reduce clot risk. These work alongside lifestyle changes to provide the best protection.

In cases of severe stenosis (70% or higher), surgical options like carotid endarterectomy or carotid artery stenting might be recommended. These procedures can restore normal blood flow and significantly reduce stroke risk.

What is the best carotid ultrasound level?

The best carotid ultrasound results show minimal stenosis (less than 50%) with normal blood flow velocities. This indicates your carotid arteries are healthy and providing adequate blood supply to your brain.

Ideal results typically include smooth artery walls without significant plaque buildup and blood flow velocities within normal ranges. Your doctor looks for consistent, uninterrupted blood flow patterns that suggest healthy, flexible arteries.

However, what's considered "best" can vary based on your age, health history, and risk factors. Some people naturally develop mild plaque buildup as they age, and this might still be considered normal for their situation.

The goal isn't necessarily perfect arteries, but rather stable, manageable results that don't pose immediate risks. Your doctor will interpret your results in the context of your overall health and help you understand what they mean for your specific situation.

What are the risk factors for carotid artery disease?

Several factors can increase your risk of developing carotid artery disease, and understanding these helps you take preventive action. Some risk factors you can control, while others are part of your natural biology.

Age and genetics play significant roles that you can't change, but knowing about them helps you stay vigilant. Men typically develop carotid artery disease earlier than women, and having family members with heart disease or stroke increases your risk.

The good news is that many risk factors are within your control. These modifiable factors have the biggest impact on your artery health:

• High blood pressure, which damages artery walls over time
• High cholesterol levels that contribute to plaque formation
• Diabetes, which affects blood vessel health throughout your body
• Smoking, which significantly accelerates plaque buildup
• Obesity, particularly excess weight around your midsection
• Sedentary lifestyle with little physical activity
• Poor diet high in saturated fats and processed foods

Some people have rare genetic conditions that affect cholesterol metabolism or blood clotting, making them more susceptible to artery disease at younger ages. Sleep apnea and chronic inflammatory conditions can also contribute to increased risk.

Understanding your risk factors helps you and your doctor decide how often you need carotid ultrasound screening and what preventive measures might be most beneficial for your situation.

Is it better to have high or low carotid stenosis?

Lower carotid stenosis is always better because it means your arteries are more open and can deliver adequate blood flow to your brain. Less stenosis reduces your risk of stroke and other serious complications.

When stenosis is low (under 50%), your arteries can usually supply all the blood your brain needs during normal activities and even during times of increased demand. This gives you a significant safety margin.

Higher stenosis becomes increasingly dangerous as it progresses. Moderate stenosis (50-69%) requires careful monitoring and treatment to prevent worsening, while severe stenosis (70% or higher) poses immediate risks that often require intervention.

However, the location and characteristics of the stenosis also matter. Sometimes a person with moderate stenosis in a critical location needs more aggressive treatment than someone with slightly higher stenosis in a less critical area.

What are the possible complications of severe carotid stenosis?

Severe carotid stenosis can lead to serious complications, with stroke being the most significant concern. When your carotid arteries are severely narrowed, your brain may not receive enough oxygen-rich blood to function properly.

The most immediate risk is ischemic stroke, which occurs when blood flow to part of your brain is completely blocked. This can happen if a blood clot forms in the narrowed artery or if a piece of plaque breaks off and travels to smaller brain vessels.

These complications can develop with severe carotid stenosis:

• Transient ischemic attacks (TIAs), often called "mini-strokes"
• Major ischemic stroke causing permanent brain damage
• Cognitive decline due to reduced blood flow to the brain
• Vascular dementia from repeated small strokes
• Complete carotid artery occlusion (blockage)
• Retinal artery occlusion affecting vision

In rare cases, severe stenosis can cause chronic brain hypoperfusion, where your brain consistently receives less blood than it needs. This can lead to subtle cognitive changes, memory problems, or difficulty concentrating.

The good news is that with proper medical care, many of these complications can be prevented even when stenosis is severe. Early detection and appropriate treatment significantly reduce these risks.

What are the possible complications of mild carotid stenosis?

Mild carotid stenosis (less than 50%) rarely causes immediate complications, but it does signal that atherosclerosis has begun in your arteries. The main concern is that mild stenosis can progress to more severe narrowing over time.

Most people with mild stenosis experience no symptoms and can live normal, active lives. However, the presence of any plaque buildup indicates that you're at higher risk for future cardiovascular problems.

Potential long-term concerns with mild stenosis include:

• Gradual progression to moderate or severe stenosis
• Development of stenosis in other arteries
• Increased risk of heart attack or stroke in the future
• Need for more frequent monitoring and medical management

In very rare cases, even mild stenosis can cause problems if the plaque is unstable and prone to rupturing. However, this is uncommon and usually associated with other risk factors.

The key with mild stenosis is prevention - taking steps to prevent progression while maintaining your current quality of life. Most people can successfully manage mild stenosis with lifestyle changes and regular monitoring.

When should I see a doctor for carotid ultrasound results?

You should see a doctor promptly if you experience any symptoms that might indicate reduced blood flow to your brain, regardless of your previous carotid ultrasound results. These symptoms require immediate medical attention.

Contact your doctor right away if you experience sudden weakness, numbness, difficulty speaking, vision changes, or severe headaches. These could indicate a stroke or transient ischemic attack, which are medical emergencies.

For routine follow-up, your doctor will schedule regular appointments based on your ultrasound results. Mild stenosis typically requires monitoring every 1-2 years, while moderate stenosis needs more frequent evaluation every 6-12 months.

You should also see your doctor if you develop new risk factors or if existing conditions like diabetes or high blood pressure become harder to control. Changes in your health status might affect your treatment plan.