Noninvasive versus invasive evaluation of the extracranial circulation in patients with suspected cerebral vascular disease

Abstract

This is the second in an ongoing series of evaluations in an attempt to find a combined system of noninvasive cerebral vascular evaluation of the extracranial circulation reliable enough so that decisions can be made, utilizing this system regarding further diagnostic studies and management. The current study evaluates a system of combined doppler arterial scanning of the extracranial circulation with Real Time B-Mode imaging of the territory of the carotid bifurcations and show that such a system, in skilled hands, is capable of very high levels of accuracy both quantitatively and qualitatively regarding the status of the carotid bifurcations as well as giving much indirect information about the cerebral vascular and subclavian circulations. The paper ends with a strong statement supporting the routine utilization of noninvasive screening of patients with suspected cerebral vascular disease. This conclusion is reached after comparing 59 patients representing 118 carotid bifurcations studied; first by physical examination and noninvasive evaluation and subsequently by angiography.