[Imaging methods in the diagnosis of carotid stenosis: is angiography obsolete?]

The aim of diagnosis is exact grading of carotid stenosis. The existence of different methods of measuring stenosis causes problems. Also, measurement of stenosis using Doppler ultrasound is based on a wholly different principle. Investigative methods for measurement of stenosis are selective angiography, CT angiography, MR angiography and duplex Doppler ultrasound. On the basis of the literature on the advantages and drawbacks, risks and accuracy of the various methods in symptomatic patients, ultrasound is recommended as the primary diagnostic tool. If Doppler ultrasound shows a stenosis of > 70%, MR angiography or CT angiography is recommended. If the results correspond, no further investigation is needed before surgery. If they do not correspond a selective carotid angiogram is required. Sonographic diagnosis of carotid occlusion needs confirmation by MR angiogram or CT angiogram.