Duplex color Doppler ultrasound evaluation of the extracranial carotid arteries has emerged as a cost-effective, reliable, non-invasive way to evaluate atheroselerotie disease and its complications. The accuracy of duplex color Doppler evaluation in the identification of hemodynamically significant disease can be greater than 90%. In daily practice, this accuracy can only be achieved if a variety of interpretive and technical pitfalls are overcome. The material presented in this manuscript is heavily illustrated with actual case examples obtained from retrospective correlation of the results of Duplex/color Doppler sonography and angiography. The cases provide a comprehensive visual tutorial of interpretative strategies and pitfalls.