Key result
Noninvasive neurovascular tests, including ultrasonic techniques and digital subtraction angiography, should guide the decision to proceed to definitive carotid arteriography.
Noninvasive neurovascular tests should combine indirect and direct methods for evaluating carotid artery disease, while carotid arteriography remains the definitive procedure reserved for when endarterectomy is contemplated.
May inform selective arteriography use; leaves open prospective validation against contemporary noninvasive standards.
Indirect noninvasive neurovascular tests provide information on hemodynamic changes cephalad to the carotid bifurcation, whereas direct tests measure anatomic or physiologic changes at the bifurcation itself. Batteries of tests are often done and should combine both indirect and direct methods. Results with two ultrasonic techniques and digital subtraction intravenous angiography suggest a larger role for these methods. Carotid arteriography is the definitive procedure for evaluating the carotid artery, although it should only be done when carotid endarterectomy is contemplated. The relative risks and benefits of other diagnostic and therapeutic management strategies should guide the decision to do noninvasive neurovascular tests, or to proceed directly to arteriography.
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Randall D. Cebul (1982) conducted a review in Carotid Artery Disease. Noninvasive neurovascular tests vs. Carotid arteriography was evaluated. Noninvasive neurovascular tests, including ultrasonic techniques and digital subtraction angiography, should guide the decision to proceed to definitive carotid arteriography.
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