Nevertheless recent recommendations of the AHA accepted duplex sonography for indicating invasive treatment of asymptomatic patients [3]. This makes evident the dependence of consensus recommendations on the time and design of selected studies. Training, quality control and certification are prerequisites before using Doppler duplex sonography for decision making. Documentation has to be comprehensive and conclusive. These prerequisites are the same as for other methods. Vascular ultrasonography find protocol is non-invasive but not “quick

and easy”. In case of definitely low or high degree disease as shown by using several main criteria, decisions may be based directly on the sonographic diagnosis. Then angiography is not justified (risk and expenses) just for additional documentation. In case of a symptomatic patient with a diagnosis in between both of these situations the decision may be based on additional imaging with angiography

(intraarterial, CTA, MRA) in case of unfavourable insonation conditions or contradictory findings. The presently available guidelines shall provide a common terminology and promote the diagnosis based on see more a set of weighted criteria. The author thanks Alfred Persson M.D. (Wellesley Massachusetts) for kindly reviewing the text. “
“Vulnerable atherosclerotic plaque rupture with surface apposition of thrombotic material is the predominant pathological substrate of acute cerebrovascular events, accounting for 30% IKBKE of all strokes [1]. In acute ischemic stroke patients, in addition to standard imaging techniques

aimed at the decision whether to perform thrombolysis, early ultrasound investigation is fundamental to detect potential embolic carotid source in order to avoid further embolization by means of carotid surgery. The aim of this report is to evaluate the possibility of early detection of these carotid plaque features with ultrasound and to discuss the implications of this diagnosis in order to plan the most appropriate strategy in acute cerebrovascular ischemic patients. All patients referred to the emergency area for the onset of acute ischemic neurological symptoms were subjected to Duplex Ultrasonography (DUS) (Siemens Sequoia 512 and Siemens S2000 apparatus), according to the conventional methodology and standard AHA and European Guidelines with high-resolution probes (9, 15, 18 MHz), Tissue Harmonics and Spatial Compound. DUS was performed immediately after brain imaging. No patients with ipsilateral (middle cerebral artery) occlusion or an ischemic area > 1/3 of the Middle Cerebral Artery area underwent carotid endarterectomy. We report 8 patients (M: 6, F: 2, mean age 64.7 yrs, range 53–78 yrs), referred to the emergency area for the onset of acute neurological symptoms occurred no more than 6 h before, in whom we detected with US immediately performed after brain CT scan, plaque features of high risk of further embolic events, as mobile thrombus over plaque ruptures.