[Ultrasonic studies and indications for angiography. Comparative study of 547 carotid arteries]

A correlation between continuous-wave Doppler sonography of 547 extracranial internal carotid arteries and angiography was established. Results were similar to those published until now: occlusions and high-grade stenoses (greater than 50%) were detected in more than 90% of the cases, whereas low-grade stenoses (less than 50%) and atheromatous plaques were detected only in 48% of the cases. In a few cases, it was difficult to distinguish total occlusion from subocclusion. As for small lesions, the results should be improved with the use of Doppler signal spectrum analysis. 87 internal carotid arteries were also examined with high resolution real-time B-mode imaging combined with pulsed Doppler (duplex system). With the exception of 10 bad quality examinations (11,4%), duplex was a very good method for the detection of every extracranial atheromatous pathology, above all for atheromatous plaques. The complementarity of conventional continuous-wave Doppler and duplex is emphasized. Whether it is possible to detect carotid artery ulcerations with real-time B-mode imaging is still a subject of controversy. Comparison between B-mode imaging and anatomopathology is discussed, with the hope that it will perhaps become possible to distinguish dangerous, embolising plaques. Ultrasound techniques are the best non-invasive ones to follow endarterectomised patients. Stenosis recurrency is probably more frequent than was thought before. Finally, the authors expose their own attitude as for the role of ultrasound in the investigation of cerebrovascular disease.