The role of extracranial ultrasound in the prevention of stroke based on the new guidelines

Extracranial ultrasonography is recommended to use as a baseline non-invasive method in the initial evaluation of either asymptomatic or symptomatic patients to define the possible stenosis on carotid artery.The latest 2011 guidelines specify the sequence of examinations with certain classification of recommendations and level of evidence.Carotid duplex ultrasonography plays an important role both in primary and secondary prevention of stroke and the results found determine the use of further investigations and management of patients with extracranial carotid and vertebral artery disease. In case of diagnostic uncertainty other brain imaging methods, like computed tomography angiography, magnetic resonance angiography and catheter-based angiography can be chosen to assess vascular lesions.Carotid duplex ultrasound serves not only diagnostic purposes but can also be useful in the follow up processes. It is widely used for control examinations after revascularization procedures of the carotid or vertebrobasilar arteries.By the establishment of indications of revascularization procedures degree of carotid stenosis is a major factor which therefore requires accuracy of the assessment. Carotid duplex ultrasound has some difficulties in this question. This diagnostic uncertainty is tried to be solved by improving the criteria system of stenosis grading in internal carotid artery.The aim of this article is to give an overview about the importance and role of extracranial duplex ultrasonography in stroke prevention based on the latest guidelines.