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So this is a case of right internal carotid artery occlusion.

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We'll start in the common carotid artery, and you can see we have nice normal flow

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in the proximal portion. As we move further up into the distal portion, again,

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we maintain our nice degree of flow.

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When we get to the carotid bulb, again, we still continue to have flow, but the

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waveform gets a little bit different.

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The peaks of soft velocities are decreasing, and as we're going through this exam,

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this should already put up some red flags that perhaps something is going on distal

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to this. And sure enough, when we get up to the proximal portion, you can start to

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see that there is some calcified plaque and some soft plaque, as well as some

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echogenic material filling the lumen up here.

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As we go further down, you can see, sure enough, that's basically where that flow

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stops. And so you can see a nice flow until it gets to this point, and then you

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don't see much. You may see the tiniest little wisp of flow beyond this point, but

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as we try to interrogate this further, we will see that essentially you get little

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blips here and there, but no true waveform. Again, a string sign here.

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And as we get to the mid portion, even after we switch to microvascular flow to try

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to pick up the tiniest little bits, we're not really picking anything up.

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So when we get a spectral waveform here, it's essentially just noise.

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This is not really any kind of reproducible thing.

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It can just be the vibrations from the tissue around it that could cause this.

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So similar findings in the distal ICA as well.

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So this was a total right ICA occlusion.