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(Stroke. 2002;33:1948.)
© 2002 American Heart Association, Inc.

Letters to the Editor

The Way Out

Franz A. Fellner, MD

Institute of Diagnostic Radiology, Friedrich-Alexander-University Erlangen-Nürnberg, Germany, Institute of Neuroradiology, Oberösterreichische Landesnervenklinik, Linz, Austria

Werner Lang, MD

Vascular Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Germany

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with great interest the article by Qureshi et al¹ and, in particular, the comments submitted by Ballotta et al² as well as the response from Qureshi et al.² Qureshi et al¹ conclude in their paper that the "present accuracy of carotid Doppler ultrasound (DUS) in general practice does not justify its use as the sole basis of selecting appropriate patients for carotid intervention." Consequently, conventional angiography (CA) should be performed in every patient before a decision regarding intervention is made. Ballotta et al² emphasized the high degree of accuracy of DUS (>90%) in accredited laboratories^3,4 and regretted the "alarming" findings cited by Qureshi et al¹ on the inaccuracy of DUS in general practice. However, these should not cast a shadow on the effectiveness of DUS as a stand-alone screening and diagnostic tool. In their reply,² Qureshi et al counter this with the results of other studies with DUS misclassification rates of 28%.⁵ More recent studies are now actually correcting the excellent results published for previous studies downward, and confirming that these excellent figures are no longer tenable.^6,7 Thus, if the indication for invasive therapy is based on ultrasound findings alone, we must consider the fact that a number of patients are needlessly subjected to invasive therapy even though they cannot possibly profit from the intervention (because they do not in reality have a high-grade stenosis at all). But they are still exposed to the risk. Alternatively, a stenosis may be incorrectly underestimated and the patient denied a logically . . . [Full Text of this Article]

Adnan I. Qureshi, MD; Stanley H. Kim, MD; M. Fareed K. Suri, MD L. Nelson Hopkins, MD

Department of Neurosurgery, Millard Fillmore Hospital, Department of Neurosurgery and Toshiba Stroke Research Center, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, New York