Referral for Carotid Ultrasound
Refer patients needing carotid ultrasound directly to a certified vascular laboratory with qualified technologists, rather than to a specific physician specialty. 1
Primary Referral Pathway
The carotid duplex ultrasound itself should be performed by a qualified technologist in a certified laboratory as the standard of care. 1 This is the Class I recommendation from the American College of Cardiology/American Heart Association guidelines and does not require referral to a specific physician specialty first. 1
Direct Laboratory Referral Options:
- Hospital-based vascular laboratories 1
- Accredited outpatient imaging centers with vascular ultrasound certification 1
- Vascular surgery practice-affiliated laboratories 1
When Specialist Referral Is Needed
After the ultrasound is completed, refer to specialists based on the findings and clinical context:
For Symptomatic Patients (TIA, stroke, amaurosis fugax):
- Vascular surgery for stenosis ≥50% requiring potential intervention 1
- Neurology for acute neurological symptoms and stroke workup 2
- Interventional neuroradiology if carotid stenting is being considered 2
For Asymptomatic Patients with Significant Stenosis:
- Vascular surgery for stenosis ≥70% to discuss revascularization options 3
- Cardiology or vascular medicine for medical management optimization 3
Common Pitfall to Avoid
Do not refer asymptomatic patients without risk factors for routine screening. 1, 4 Carotid duplex ultrasonography is explicitly not recommended for routine screening of asymptomatic patients who have no clinical manifestations of or risk factors for atherosclerosis. 1, 4 This represents a Class III (No Benefit) recommendation. 1
Quality Assurance Consideration
Ensure the laboratory you refer to maintains correlation of findings between multiple imaging modalities as part of their quality assurance program. 1, 5 Vascular surgery specialists have been shown to order carotid ultrasound more appropriately (odds ratio 3.52) compared to other specialties. 6