SVU 2025 Annual Conference Extracranial Session-SVU 2025 Annual Conference Extracranial Session

Video Transcription

Video Summary

The session focused on advances and challenges in carotid artery imaging and diagnosis, moderated by Dr. Eugene Zehler. He reviewed the history of carotid ultrasound criteria, highlighting the evolution from early B-mode and Doppler techniques in the 1970s to current standards. The University of Washington (UW) Stranis lab criteria, particularly the 125 cm/s peak systolic velocity (PSV) threshold for detecting >50% stenosis, though widely used, were noted to overestimate stenosis severity according to recent multicenter International Accreditation Commission (IEC) studies, which recommend raising the PSV threshold to 180 cm/s for better accuracy.<br /><br />Dr. David Williams discussed carotid surgical intervention and post-operative evaluation, emphasizing thorough and empathetic duplex protocols, the importance of walking the Doppler sample volume through the operative site, and recognizing imaging differences post-surgery. He illustrated with a long-term case of a pseudoaneurysm and patch maintenance over 13 years, underscoring the value of informed, patient-centered vascular technologists.<br /><br />Steve Knight examined the variability and dilemmas in carotid duplex measurement methodologies, emphasizing the need for standardization, particularly in Doppler angle use and plaque description. He highlighted ongoing debates about specificity, interpretation, and the absence of definitive criteria for high-grade stenosis, urging more robust studies and consistent protocols.<br /><br />Dr. Rachelle Finch introduced contrast-enhanced ultrasound (CEUS) for carotid plaque characterization, demonstrating its ability to detect plaque neovascularization—a marker of vulnerability—and suggesting CEUS’s potential future role in clinical practice despite current experimental status. Discussions stressed the need for better plaque characterization methods, integration into clinical guidelines, and mentorship for technologists to enhance imaging quality and patient care. The importance of standardized velocity thresholds, education, and balancing clinical workload with quality imaging was also noted throughout the session.

Keywords

carotid artery imaging

carotid ultrasound criteria

peak systolic velocity threshold

stenosis detection

duplex ultrasound protocols

post-operative vascular evaluation

pseudoaneurysm case study

carotid duplex measurement variability

Doppler angle standardization

contrast-enhanced ultrasound (CEUS)

plaque neovascularization detection