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(Stroke. 2003;34:1331.)
© 2003 American Heart Association, Inc.

Comments, Opinions, and Reviews

Editorial Comment—Funeral for a Friend

Institute of Diagnostic and Interventional Radiology, Department of Neuroradiology, University of Essen, Essen, Germany

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

This editorial is not written by Elton John, and the funeral is not for Marilyn Monroe. We are neuroradiologists, and it is probably time to say farewell to diagnostic digital substraction angiography (DSA) in patients with carotid artery stenosis.

Moniz,¹ a Portuguese neurologist, brought cerebral angiography to life in 1927, and since then, techniques have improved continuously up to ultrasoft catheters and high-resolution biplane angiography equipment. However, despite all these improvements, it is still risky to inject a contrast agent into the cerebral circulation.² We all are hopeful that visualization of supra-aortal vessels might be possible some day without any risk to the patient.

Ultrasound with its variants was a major step forward toward noninvasive imaging of the carotid bifurcation.^3,4 Depending on the person who did the examination, it became a perfect screening tool and replaced DSA for presurgical workup in those institutions in which experienced "ultrasounders" and vascular surgeons had the opportunity to work and learn together. However, it is highly observer dependent, and DSA remained the gold standard. As a consequence, we all perform many diagnostic angiographies in patients with internal carotid artery (ICA) stenosis who had at least 1 Doppler ultrasound examination previously.

In 1985, a Science article by Wedeen and colleagues⁵ established the next milestone: Projective imaging of pulsatile flow was possible with MR, and it works without contrast agent injection. At that time, image quality was bad; temporal and spatial resolution was far beyond from being satisfactory. But since then, MR angiography (MRA) became an . . . [Full Text of this Article]

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