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Fig. 2. —66-year-old woman with high-grade atherosclerotic stenosis of proximal right internal carotid artery and parvus–tardus waveforms in mid internal carotid artery. Spectral Doppler sonography tracings distal to stenosis show diminished peak systolic amplitude (pulsus parvus) and prolonged systolic acceleration evident in delayed systolic upstroke and rounded systolic peak (pulsus tardus). This waveform most often results from high-grade stenosis, which may occur anywhere from aortic valve to carotid arteries. If stenosis is central, such as aortic valvular disease, parvus–tardus waveforms are often identified within both carotid arteries.