Comparison of duplex Doppler scanning with contrast angiography in carotid artery disease

The results of ultrasonic pulsed Doppler duplex scanning with spectral analysis were compared with the results of contrast arteriography in 37 patients screened for extracranial carotid artery disease. The kappa value for this comparison was 0.476 +/- 0.149. The overall diagnostic accuracy of duplex scanning was 91% (67/74 vessels) for agreement within one category of true assessment of stenosis. All 5 occluded internal carotid arteries were identified correctly by duplex scanning. Duplex scanning of the internal carotid artery is one of the few noninvasive tests that has the capability of discriminating normal arteries from minimal disease, minimal disease from severe disease, and severe disease from occlusion. Duplex scanning should be used as the initial test in patients with non-hemispheric symptoms and complete stroke. The intra-operative and postoperative routine assessment of the endarterectomised segment has become mandatory. Duplex scanning is invaluable in the management of the patient with an asymptomatic carotid bruit.