One should always demonstrate the bulb when taking a Doppler sample of distal CCA. You can also see that the spectral Doppler is displaying a high resistance waveform, which is typical of a proximal CCA. Flow here in the Carotid has not had time to turn into a low resistance state, as it is too close to the heart. Not until further distal does it change to lower resistance, as it then is converting to feed a low resistance bed, the brain. If this was truly a distal CCA waveform, demonstrating such high resistance, one should be concerned about a significant ICA stenosis. Key to remember in vascular: Systole tells you if there is a proximal problem; Diastole tells you if a distal problem exists.

very nice case thank you

Anything can cause proximal to proximal CCA stenosis, like Aortic stenosis, will cause this wave form.

it's very nice case and if could provide more. Thanks