In the submandibular approach, which vessels are assessed?

• A. retromandibular and proximal intracranial ICA
• B. ophthalmic artery
• C. MCA
• D. basilar artery

Answer: (A)

The submandibular approach is used to image two parts of the internal carotid artery as it travels toward and into the skull: the distal extracranial ICA behind the mandible (retromandibular region) and the proximal intracranial ICA as it approaches the brain. This window is chosen because it lines up with the ICA’s path in those segments, allowing Doppler assessment of flow velocity, stenosis, or occlusion in those areas.

The other vessels listed aren’t the focus of this window: the ophthalmic artery is a branch of the ICA and isn’t reliably evaluated from the submandibular route; the MCA is best assessed through the temporal window; and the basilar artery lies in the posterior circulation, accessed via different windows such as suboccipital.