Noninvasive neurovascular tests for carotid artery disease

Indirect noninvasive neurovascular tests provide information on hemodynamic changes cephalad to the carotid bifurcation, whereas direct tests measure anatomic or physiologic changes at the bifurcation itself. Batteries of tests are often done and should combine both indirect and direct methods. Results with two ultrasonic techniques and digital subtraction intravenous angiography suggest a larger role for these methods. Carotid arteriography is the definitive procedure for evaluating the carotid artery, although it should only be done when carotid endarterectomy is contemplated. The relative risks and benefits of other diagnostic and therapeutic management strategies should guide the decision to do noninvasive neurovascular tests, or to proceed directly to arteriography.