Carotid Duplex imaging is better modality than Angiography to diagnose carotid artery stenosis in patients for Endarterectomy

Abstract

Carotid duplex imaging is now recognized as the best non-invasive screening test for carotid artery stenosis. The evidence for its use as the sole diagnostic imaging modality prior to carotid Endarterectomy is examined. Providing it is carried out by experienced trained operators using validated duplex criteria, carotid duplex imaging is safe, highly sensitive and specific, and superior to angiography at plaque characterization & evaluation of flow disturbance. Cerebral CT & MRI should be performed if symptoms are atypical or if there is an evolved stroke. Angiography is required when duplex imaging is sub optional or equivocal, in the presence of atypical symptoms or uncommon vascular abnormalities. In the majority of patients requiring Endarterectomy for symptomatic high grade ICA stenosis, angiography seldom adds relevant information, clinical assessment & carotid duplex imaging alone can be safely used in preoperative assessment.