Pitfalls in Carotid Doppler Interpretation and How to Avoid Them

Imaging pitfalls commonly occur in carotid Doppler ultrasound and may lead to false positive diagnosis of stenosis, missed diagnosis of stenosis, and errors in grading stenosis severity. These pitfalls may result from suboptimal technique and/or patient‐specific factors including coexisting cardiovascular pathology, contralateral high‐grade stenosis/occlusion, tortuous vessels, tandem lesions, long‐segment stenosis, nearly occlusive stenosis, and heavily calcified plaque. Awareness of these pitfalls and careful assessment of the extent of plaque on grayscale and color Doppler as well as analysis of the spectral Doppler waveforms can help avoid misinterpretation of the carotid Doppler examination.