Intravenous DSA of extracranial carotid lesions: comparison with other techniques and specimens

Intravenous digital subtraction arteriography (DSA) was performed in 306 patients with suspected ischemic cerebrovascular disease. Forty-eight carotid endarterectomies were performed in 43 of these patients. The percentage stenosis as determined on the intravenous DSA examination concurred (+/- 10%) with the surgical findings in 83.3%. There were 12.5% undercalls (false-negatives) and 4.3% overcalls (false-positives). Of the false-negative and false-positive examinations only three would have affected the clinical management of the patient, yielding an overall sensitivity of 93.7%. Nine surgical lesions had both intravenous DSA and conventional arteriography. Intravenous DSA was correct in six and arteriography in seven of these lesions. There were four surgically confirmed ulcerations. Two were evaluated by intravenous DSA alone. Two had intravenous DSA and arteriography. The latter showed both ulcers; the former, only one. Thirty-seven surgical lesions had both intravenous DSA and high-resolution real-time sonographic imaging. Sonography agreed in 67.5% and intravenous DSA in 83.7% of these lesions. When an abnormal supraorbital Doppler or an abnormal oculopneumoplethysmography/Gee examination is added to the sonographic examination, an overall sensitivity of 93% was obtained in detecting a surgical lesion (stenosis greater than 50%).