Carotid Doppler: for whom, and how often

Clinical criteria that justify screening, and the difference between hemodynamically significant stenosis and an incidental finding.

Carotid Doppler is often ordered outside the context that actually justifies the workup. An asymptomatic cervical bruit, for instance, has limited predictive value on its own — yet it still drives a substantial share of the requests.

Scenarios with a stronger indication

Recent stroke or transient ischemic attack, a carotid bruit associated with relevant cardiovascular risk factors, and post-endarterectomy or post-stent follow-up account for most of the indications with consistent support in the literature.

Stenosis isn't just a percentage

Quantification using peak systolic velocity criteria and velocity ratios is more reliable than visually estimating the percentage of stenosis — especially in heterogeneous, calcified plaques, where acoustic shadowing limits direct morphologic assessment.