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Review
. 2025 Oct 6;14(19):7050.
doi: 10.3390/jcm14197050.

Operative Procedures for Ultrasound Assessment of Extracranial Artery Disease: A Narrative Review by the Italian Society for Vascular Investigation (SIDV)

Luca Costanzo  1 , Giacomo Failla  1 , Leonardo Aluigi  2 , Tiziana Anna Baroncelli  3 , Chiara Bua  4 , Sergio De Marchi  5 , Elia Diaco  6 , Federico Di Paola  7 , Francesco Lorenzo Di Pino  4 , Ferdinando Mannello  8 , Ombretta Martinelli  9 , Chiara Mascoli  10 , Anastasia Maria Pedi  4 , Ivan Privitera  11 , Enrico Rescigno  12 , Antonio Trani  13 , Pier Luigi Antignani  14 , Marco Mangiafico  4
Affiliations
Review

Operative Procedures for Ultrasound Assessment of Extracranial Artery Disease: A Narrative Review by the Italian Society for Vascular Investigation (SIDV)

Luca Costanzo et al. J Clin Med. .

Abstract

Background: Duplex ultrasonography (DUS) of the extracranial arteries is essential for the primary and secondary prevention of ischemic stroke and the diagnosis of other cerebrovascular pathologies. The aim of the Italian Society for Vascular Investigation (SIDV) is to provide a standardised approach for the ultrasound evaluation of extracranial arterial disease. Methods: A multidisciplinary SIDV expert panel conducted a comprehensive literature search and performed a narrative review of the recent medical literature; the updated operative procedures were subsequently developed through a consensus-driven process that included dedicated meetings and national congress sessions for discussion and validation. Results: This document outlines a comprehensive approach to the ultrasound evaluation of extracranial arteries, detailing techniques such as Brightness Mode (B-mode), Colour Doppler, Power Doppler, contrast-enhanced ultrasound (CEUS), micro-vascular flow imaging (MVFI), and Three-Dimensional (3D) ultrasound. The text provides an in-depth discussion of clinical indications, technical protocols, plaque characterisation, stenosis quantification, and hemodynamic criteria. Emerging technologies are also examined for their potential to improve cerebrovascular risk stratification. Conclusions: The updated SIDV operative procedures for the ultrasound evaluation of extracranial cerebrovascular disease are intended to serve as a valuable reference for clinicians and vascular laboratories.

Keywords: CEUS; carotid disease; carotid ultrasound; duplex ultrasonography; extracranial artery disease; ultrasound; vascular.

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Conflict of interest statement

Author Elia Diaco was employed by the company Minerva Surgical Service. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Patient and operator position for carotid ultrasound study.
Figure 2
Figure 2
Automatic IMT measurement of far walls of the left common carotid artery using Auto IMT™ software (RS 85, Samsung Medison diagnostic ultrasound system, version 1.05, SAMSUNG MEDISON CO., LTD., 3366, Hanseo-ro, Nam-myeon, Hongcheon-gun, Gangwon-do 25108, Republic of Korea).
Figure 3
Figure 3
NASCET methods [(B − A)/B × 100% stenosis] for measuring the degree of carotid stenosis. B: residual diameter at the stenosis point; A: distal diameter of the internal carotid.
Figure 4
Figure 4
ECST method [(C − B)/C × 100% stenosis] for measuring the degree of carotid stenosis. C: estimated diameter of the interna carotid; B: residual diameter at the stenosis point.
Figure 5
Figure 5
Metz’s classification of carotid kinking. Dotted lines drawn along the axis of the internal carotid artery show the curvature of the vessel less than 90° (left) or 60° (centre) or 30° (right). Adapted and modified from Metz H et al. [175].
See this image and copyright information in PMC

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