Annals of Vascular Surgery

, Volume 1, Issue 4, pp 489–498 | Cite as

Noninvasive assessment of cerebrovascular disease

  • Marian McNamara
  • Gregory L. Moneta
  • David C. Taylor
  • D. Eugene Strandness
General Review


Of the wide variety of noninvasive carotid examinations available, Duplex scanning offers the best combination of accuracy and detection of all clinically important lesions. Extensive technician training is required and the initial cost of the instrument is high, but the versatility of the method and a low cost per patient makes Duplex scanning cost effective. When high initial capital investments are not possible the use of pressure OPG or simple continuous-wave Doppler devices are satisfactory alternatives to screen for high grade lesions.


Carotid Artery Internal Carotid Carotid Endarterectomy Carotid Stenosis Carotid Artery Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    HAAS W, FIELDS W, NORTH R et al. Joint study of extracranial arterial occlusion: II. Arteriography, techniques. sites and complications.JAMA 1968;203: 159–166.Google Scholar
  2. 2.
    PENDERGRASS HP, HODES PJ, TONDREAU RL et al. Further considerations of deaths and unfavorable sequelae following the administration of contrast media in urography in the United States.AJR 1955;74: 262–287.Google Scholar
  3. 3.
    FISHER M. Occlusion of the carotid artery—further experiences.Arch Neurol Psychiatry 1954;72: 187–204.Google Scholar
  4. 4.
    ROEDERE GO, LANGLOIS YE, JAGER KA et al. The natural history of carotid artery disease in asymptomatic patients with cervical bruits.Stroke 1984;15: 605–613.Google Scholar
  5. 5.
    MOORE WS, BOREN C, MALONE JM et al. Natural history of nonstenotic, asymptomatic ulcerative lesions of the carotid artery.Arch Surg 1978;113: 1352–1359.PubMedGoogle Scholar
  6. 6.
    IMPARATO AM, RILES TS, GORSTEIN F. The carotid bifurcation plaque: pathologic findings associated with cerebral ischemia.Stroke 1979;10: 238–245.PubMedGoogle Scholar
  7. 7.
    LUSBY RJ, FERRELL LD, EHRENFELD WK et al. Carotid plaque hemorrhage—its role in production of cerebral ischemia.Arch Surg 1982;117: 1479–1488.PubMedGoogle Scholar
  8. 8.
    THIELE BL, YOUNG JV, CHIKOS PM et al. Correlation of arteriographic findings and symptoms in patients with cerebrovascular disease.Neurology 1980;30: 1041–1045.PubMedGoogle Scholar
  9. 9.
    BROCKENBROUGH EC. Periorbital Doppler velocity evaluation of carotid obstruction.In: BERNSTEIN EF. ed.Noninvasive Diagnostic Techniques in Vascular Disease. St. Louis, CV Mosby. 1982: 335–344.Google Scholar
  10. 10.
    BARNES RW, RUSSELL HE, BONE GE et al. Doppler cerebrovascular examination: improved results with refinements in technique.Stroke 1977;8: 468–471.PubMedGoogle Scholar
  11. 11.
    TROCKEL U, HENNEVICI M, AULICH A et al. The superiority of combined continuous wave Doppler examination over periorbital Doppler for the detection of extracranial carotid disease.J Neurol Neurosurg Psychiatry 1984;47: 43–50.PubMedCrossRefGoogle Scholar
  12. 12.
    BAKER JD. How vascular surgeons use noninvasive testing.J Vasc Surg 1986;4: 272–276.PubMedCrossRefGoogle Scholar
  13. 13.
    KARTCHNER MM, MCRAE LP, MORRISON FD. Noninvasive detection and evaluation of carotid occlusive disease.Arch Surg 1978;106: 528–535.Google Scholar
  14. 14.
    FRONEK A. Oculoplethysmography.In: BERNSTEIN EF, ed.Noninvasive Diagnostic Techniques in Vascular Disease. St Louis, CV Mosby, 1982: 323–329.Google Scholar
  15. 15.
    LEES RS. Phonoangiography: qualitative and quantitative.Ann Biomed Eng 1984;12: 55–62.PubMedCrossRefGoogle Scholar
  16. 16.
    KARTCHNER MM, MCRAE LD. Noninvasive evaluation and management of the «asymptomatic» carotid bruit.Surgery 1977;82: 840–847.PubMedGoogle Scholar
  17. 17.
    MCDONALD PT, RICH NM, COLLINS GJ et al. Doppler cerebrovascular examination. oculoplethysmography and ocular pneumoplethysmography.Arch Surg 1978;113: 1341–1349.PubMedGoogle Scholar
  18. 18.
    BLACKSHEAR WM, THIELE BL, HARLEY JD et al. A prospective evaluation of oculoplethysmography and carotid phonoangiography.Surg Gynecol Obstet 1979;148: 201–205.PubMedGoogle Scholar
  19. 19.
    KEAGY BA, PHARR WF, THOMAS DD et al. Oculoplethysmography/carotid phonoangiography—its value as a screening test in patients with suspected carotid artery stenosis.Arch Surg 1980;115: 1199–1202.PubMedGoogle Scholar
  20. 20.
    GEE W, OLLER DW, WYLIE EJ. Noninvasive diagnosis of carotid occlusion by ocular pneumoplethysmography.Stroke 1976;7: 18–21.PubMedGoogle Scholar
  21. 21.
    GEE W, MEHIGAN JT, WYLIE EJ. Measurement of collateral cerebral hemispheric blood pressure by ocular pneumoplethysmography.Am J Surg 1975;130: 121–127.PubMedCrossRefGoogle Scholar
  22. 22.
    BANDYK DF, THIELE BL. Noninvasive assessment of carotid artery disease.West J Med 1983;139: 486–501.PubMedGoogle Scholar
  23. 23.
    EIKELBOOM BC, RILES TS, FOLCARELLI D et al. Criteria for interpretation of ocular pneumoplethysmography (Gee).Arch Surg 1983;118: 1169–1172.PubMedGoogle Scholar
  24. 24.
    MCDONALD PT, RICH NM, COLLINS GJ et al. Ocular pneumoplethysmography: Detection of carotid occlusive disease.Ann Surg 1979;189: 44–48.PubMedCrossRefGoogle Scholar
  25. 25.
    BAKER JD, BARKER WF, MACHLEDER HI. Ocular pneumoplethysmography in the evaluation of carotid stenosis.Circulation 1980;62: (Suppl 1).Google Scholar
  26. 26.
    EIKELBOOM BC. Evaluation of carotid artery disease and potential collateral circulation by ocular pneumoplethysmography.Thesis. Utrecht. The Netherlands, 1981.Google Scholar
  27. 27.
    ABU RAHMA AF, DIETHRICH EB. Comparison of various oculoplethysmography modalities.J Vasc Surg 1985;2: 288–291.CrossRefGoogle Scholar
  28. 28.
    EIKELBOOM BC. Ocular pneumoplethysmography.In: BERNSTEIN Ef, ed.Noninvasive Diagnostic Techniques in Vascular Disease. St. Louis, CV Mosby, 1982: 330–334.Google Scholar
  29. 29.
    KREMEN JE, GEE W, KAUPP HA et al. Restenosis or occlusion after carotid endarterectomy.Arch Surg 1979;114: 608–610.PubMedGoogle Scholar
  30. 30.
    ZIERLER RE, BANDYK DF, THIELE BL et al. Carotid artery stenosis following endarterectomy.Arch Surg 1982;117: 1408–1415.PubMedGoogle Scholar
  31. 31.
    LEES RS, DEWEY FC Jr. Phonoangiography: A New noninvasive diagnostic method for studying arterial disease.Proc Natl Acad Sci USA 1970;67: 935–942.PubMedCrossRefGoogle Scholar
  32. 32.
    DUNCAN GW, GRUBER JO, DEWEY CF Jr et al. Evaluation of carotid stenosis by phonoangiography.N Engl J Med 1975;293: 1124–1128.PubMedCrossRefGoogle Scholar
  33. 33.
    KNOW R, BRESLAU P, STRANDNESS DE Jr. Quantitative carotid phonoangiography.Stroke 1981;12: 798–803.Google Scholar
  34. 34.
    KISTLER JP, LEES RS, MILLER A et al. Correlation of spectral phonoangiography and carotid angiography with gross pathology in carotid stenosis.N Engl J Med 1981;305: 417–419.PubMedCrossRefGoogle Scholar
  35. 35.
    GILROY J, MEYER JS. Auscultation of the neck in occlusive cerebrovascular disease.Circulation 1962:25: 300–310.PubMedGoogle Scholar
  36. 36.
    PEART WS, ROB C. Arterial auscultation.Lancet 1960;2: 219–220.CrossRefGoogle Scholar
  37. 37.
    SILVERSTEIN A, LEHRER GM, MONES R. Relation of certain diagnostic features of carotid occlusions to collateral circulation.Neurology 1960;10: 409–417.PubMedGoogle Scholar
  38. 38.
    ZIEGLER DK, ZILELI T, DICK A et al. Correlation of bruits over the carotid artery with angiographically demonstrated lesions.Neurology 1971;21: 860–865.PubMedGoogle Scholar
  39. 39.
    BARNES RW. Continuous-wave Doppler ultrasound.In: BERNSTEIN EF, ed.Noninvasive Diagnostic Techniques in Vascular Disease, St. Louis, CV Mosby, 1985: 19–24.Google Scholar
  40. 40.
    SPENCER MP, REID JM. Quantitation of carotid stenosis with continuous-wave (CW) Doppler ultrasound.Stroke 1979;10: 326–330.PubMedGoogle Scholar
  41. 41.
    BROWN PM, JOHNSTON KW, KASSAM M et al. A critical study of ultrasound Doppler spectral analysis for detecting carotid disease.Ultrasound Med Biol 1982;8: 515–523.PubMedCrossRefGoogle Scholar
  42. 42.
    ZIERLER RE, ROEDERER GO, STRANDNESS DE Jr. The use of frequency spectral analysis in carotid artery surgery.In: BERGAN JI, YAO JST, eds.Cerebrovascular Insufficiency, New York, Grune & Stratton, 1983: 137–163.Google Scholar
  43. 43.
    JOHNSTON KW, BAKER WH, BURNHAM SJ et al. Quantitative analysis of continuous-wave Doppler spectral broadening for the diagnosis of carotid disease: Results of a multicenter study.J Vasc Surg 1986;4: 493–504.PubMedCrossRefGoogle Scholar
  44. 44.
    BARNES RW, BONE GE, REINERTSON J et al. Noninvasive ultrasonic carotid angiography: Prospective validation by contrast angiography.Surgery 1976;80: 328–335.PubMedGoogle Scholar
  45. 45.
    SUMNER DS, MOORE DJ, MILES RD. Doppler ultrasonic arteriography and flow velocity analysis in carotid artery disease.In: BERNSTEIN EF, ed.Noninvasive Diagnostic Techniques in Vascular Disease. St. Louis, CV Mosby, 1985: 349–366.Google Scholar
  46. 46.
    COMEROTA AJ, CRANLEY JJ, KATZ ML et al. Real-time B-mode carotid imaging: A three-year multicenter experience.J Vasc Surg 1984;1: 84–95.PubMedCrossRefGoogle Scholar
  47. 47.
    COOPERBERG PL, ROBERTSON WD, FRY P et al. High resolution real time ultrasound of the carotid bifurcation.J Comput Ultrasound 1979;7: 13–17.CrossRefGoogle Scholar
  48. 48.
    BLUTH EI, KAY D, MERRITT CRB et al. Sonographic characterization of carotid plaque: detection of hemorrhage.AJR 1986;146: 1061–1065.PubMedGoogle Scholar
  49. 49.
    REILLY LM, LUSBY RJ, HUGHES L et al. Carotid plaque histology using real-time ultrasonography: Clinical and the-rapeutic implications.Am J Surg 1983;146: 188–193.PubMedCrossRefGoogle Scholar
  50. 50.
    DILLEY RB, BERNSTEIN EF. A comparison of B-mode real-time imaging andarteriography in the intraoperative assessment of carotid endarterectomy.J Vasc Surg 1986;4: 457–463.PubMedCrossRefGoogle Scholar
  51. 51.
    BAUBER FE, BAKER DW, NATION WC et al. Ultrasonic duplex echo-Doppler scanner.IEEE Trans Biomed Eng 1974;21: 109–113.CrossRefGoogle Scholar
  52. 52.
    ROEDERER GO, LANGLOIS YE, CHAN ATW et al. Ultrasonic duplex scanning of the extracranial carotid arteries: Improved accuracy using new features from the common carotid artery.J Cardiovasc Ultrasonography 1982;1: 373–380.Google Scholar
  53. 53.
    ROEDERER GO, LANGLOIS YE, JAGER KA et al. A simple spectral parameter for accurate classification of severe carotid disease.Bruit 1984;8: 174–178.Google Scholar
  54. 54.
    ROEDERER GO, LANGLOIS YE, CHAN ARW et al. Is siphon disease important in predicting outcome of carotid endarterectomy?Arch Surg 1983;118: 1177–1181.PubMedGoogle Scholar
  55. 55.
    BAKER JD. The vascular laboratory.In: MOORE WS, ed.Vascular Surgery—A Comprehensive Review (2nd ed), Orlando, Florida, Grune & Stratton, 1986: 205–240.Google Scholar
  56. 56.
    LEES RS, MEYERS GS. Noninvasive diagnosis of vascular disease.In:Advances in Internal Medicine, Vol 27, Chicago, Year Book Medical Publishers, 1982: 475–509.Google Scholar
  57. 57.
    BERGUER R. Carotid artery noninvasive testing is being overused.Stroke 1983;14: 819–821.PubMedGoogle Scholar
  58. 58.
    THOMPSON JE, AUSTIN DJ, PATMAN RD. Carotid endarterectomy for cerebrovascular insufficiency: long-term results in 592 patients followed up to thirteen years.Surg Clin North Am 1986;66: 233–253.PubMedGoogle Scholar
  59. 59.
    BERNSTEIN EF, HUMBER PB, COLLINS GM et al. Life expectancy and late stroke following carotid endarterectomy.Ann Surg 1983;198: 80–86.PubMedCrossRefGoogle Scholar
  60. 60.
    The EC/IC Bypass Study Group: Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: Results of an international randomized trial.N Engl J Med 1985;313: 1191–1200.CrossRefGoogle Scholar
  61. 61.
    BOGOUSSLAUSKY J, REGLI F, HUNGERBUHLER J et al. Transient ischemic attacks and external carotid surgery: a retrospective study of 23 patients with an occlusion of the internal carotid artery.Stroke 1981;12: 627–630.Google Scholar
  62. 62.
    THOMPSON JE, PATMAN RD, TALKINGTON CM. Asymptomatic carotid bruit: long term outcome of patients having endarterectomy compared with unoperated controls.Ann Surg 1978;188: 308–316.PubMedCrossRefGoogle Scholar
  63. 63.
    HEYMAN A, WILKINSON WE, HEYDEN S et al. Risk of stroke in asymptomatic persons with cervical bruits: a population study in Evans County, Georgia.N Engl J Med 1980;302: 838–841.PubMedCrossRefGoogle Scholar
  64. 64.
    BOGOUSSLARSKY J, DISPLAND PA, REGLI F. Asymptomatic tight stenosis of the internal carotid artery: Long term prognosis.Neurology 1986;36: 861–863.Google Scholar
  65. 65.
    CHAMBERS BR, NORRIS JW. Outcome in patients with asymptomatic neck bruits.N Engl J Med;315: 860–865.Google Scholar
  66. 66.
    RILES TS, KOPELMAN I, IMPARATO AM. Myocardial infarction following carotid endarterectomy: A review of 684 operations.Surgery 1979;85: 249–252.PubMedGoogle Scholar
  67. 67.
    SEIFERT KB, BLACKSHEAR WM. Continuous wave Doppler in the intraoperative assessment of carotid endarterectomy.J Vasc Surg 1985;2: 817–820.PubMedCrossRefGoogle Scholar
  68. 68.
    ZIERLER RE, BANDYK DF, THIELE BL. Intraoperative assessment of carotid endarterectomy,J Vasc Surg 1984;1: 73–83.PubMedCrossRefGoogle Scholar
  69. 69.
    HERTZER NR, MARTINIEZ BD, BEVON EG. Recurrent carotid stenosis after carotid endarterectomy.Surg Gynecol Obstet 1979;149: 360–364.PubMedGoogle Scholar
  70. 70.
    STONEY RJ, STRONG ST: Recurrent carotid stenosis.Surgery 1976;80: 705–710.PubMedGoogle Scholar

Copyright information

© Annals of Vascular Surgery Inc 1987

Authors and Affiliations

  • Marian McNamara
    • 1
  • Gregory L. Moneta
    • 2
  • David C. Taylor
    • 2
  • D. Eugene Strandness
    • 2
  1. 1.Detroit
  2. 2.Department of Surgery, RF-25University of Washington, School of MedicineSeattle

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