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(Stroke. 1995;26:1743-1746.)
© 1995 American Heart Association, Inc.

Articles

Skepticism Toward Carotid Ultrasonography

A Virtue, an Attitude, or Fanaticism?

E.B. Ringelstein, MD

From the Klinik und Poliklinik für Neurologische, Westfalische Wilhelms-Universität Münster (Germany).

Correspondence to Prof E.B. Ringelstein, MD, Klinik und Poliklinik für Neurologische, Westfalische Wilhelms-Universität Münster, Albert Schweitzer Str 33, Münster, Germany.

Key Words: carotid arteries • ultrasonics • carotid endarterectomy • diagnostic imaging

	Introduction

 
Routine ultrasonography of the brain-supplying arteries is not a well-defined procedure. It may range from simple periorbital directional flow assessment to highly sophisticated imaging of the carotid arteries, or even thorough workup of all sonographically accessible extracranial and intracranial brain arteries.¹ Continuous-wave Doppler sonography with or without frequency analysis is still widely used, but today color-coded B-mode imaging in conjunction with transcranial Doppler sonography is the state-of-the-art technique.^{2 3 4 5} The latter was not used during the North American Symptomatic Carotid Endarterectomy Trial (NASCET).⁶

The detection of carotid artery occlusive disease by means of ultrasound has its own nearly 40-year history.⁷ Broad acceptance of ultrasound investigations in neurovascular patients was first achieved in the late 1970s after introduction of the direct continuous-wave Doppler technique continuously tracking the cervical portions of the carotid arteries.^{8 9} Further considerable diagnostic improvement became reality by the introduction of B-mode scanning of the carotid bulb in conjunction with Doppler ultrasound.^{10 11} This duplex scanning permitted detection of not only moderate or high-grade stenoses and occlusions but also nonstenosing plaques and low-grade stenoses and allowed for the correct diagnosis of acute internal carotid artery thrombosis despite an echolucent arterial lumen.¹² Finally, color-coded B-mode imaging in conjunction with frequency analysis made the distinction between internal carotid artery occlusion and pseudo-occlusion (ie, "near occlusion") highly reliable.¹³ The oncoming ultrasound contrast media¹⁴ and new ultrasound techniques like power Doppler¹⁵ will additionally contribute to future improvement and will help to close (or at least reduce) the remaining diagnostic gaps. The quantification of carotid artery . . . [Full Text of this Article]

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