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So here's an example of a carotid that would fall into the 50% to 69% stenosis

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bucket. So here, as we go through the proximal common carotid artery, we can start

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to see a little bit of plaque, not a ton, and nice, good color Doppler throughout.

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We are actually seeing a little bit of aliasing here, so there could be a little

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bit of adjustment in that waveform, ideally.

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And then as we move down, we again continue to see some little bits of plaque,

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primarily calcified plaque, but there's a little bit of soft plaque as well.

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And then as we continue to progress, we get to the carotid bulb.

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Again, continue to see a little bit more buildup of this, which is this hypoechoic

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plaque, which is more soft,

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and some mixed areas of hyperechoic plaque, which is more calcified.

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We're here progressing through the bulb, so the bifurcation, and now we get to the

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proximal ICA. You can see that we're starting to get a little bit of shadowing from

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plaque here, which can limit the ability for us to get waveforms in that area, so

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we have to be careful when we see that.

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But when we're in here in the proximal portion, we are able to elicit a waveform.

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And you can see here we don't have any velocity elevations, but we can already

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start to see a little bit of turbulence that's starting to come in here.

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So as we start to interrogate into that area, you can see now velocity starts to

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elevate. And so here we have over 180 centimeters per second.

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So whether we're using the updated criteria or the classic criteria, this would

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both be within the velocity window for the 50% to 69% stenosis.

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Again, we are seeing a visual stenosis here, plus a velocity stenosis as

1:39

well.

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As we move further down, we are seeing some slight elevations, but not enough to

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meet the new criteria for velocity elevation.

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And then same thing, a little bit more distal.

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When we look on the additional side, we'll see one example of what we call the

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temporal tap. You can see that is reverberation of this distal portion of the ECA

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waveform, and so that is somebody physically tapping on the temporal artery, and

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that's causing that little reverberation to help us identify where we are.

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And then when we look on the other side, we may still see some plaque.

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So we see some soft plaque here.

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Again, continues into the distal CCA.

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And as we move up to the bulb, again, we are seeing more plaque

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with similar findings as we get into the proximal ICA.

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However, the proximal ICA over here looks like a much clearer channel than what we

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can see. And we can see when we look at our waveform here

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that we do not see any elevations in the peak systolic velocity, so it's within

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normal limits.

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Same in the mid ICA,

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and then same in the distal ICA as well.

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So this was consistent with 50% to 69% stenosis on the right and no significant

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stenosis, less than 50%, on the left.