A comparison of Doppler flow measurements, ultrasonic and arteriographic imaging in the evaluation of stenoses of the carotid artery.

To determine the value of Doppler periorbital flow measurements (DOP) and real-time ultrasonic in the analysis of carotid artery occlusive disease, 1,203 carotid arteries were evaluated in 669 consecutive patients from 1 June 1980 to 1 July 1981. The results of DOP and US were compared with biplane carotid arteriograms using the Seldinger technique. The stenoses were graded: Grade I (zero to 25 per cent), Grade II (25 to 50 per cent), Grade III (50 to 75 per cent) and Grade IV (75 to 100 per cent). Both US and CA agreed in 71.3 per cent of 209 arteries. US and DOP were performed together in 1,203 arteries and agreed in 83.2 per cent. The flow surfaces of an additional 29 arteries were visually inspected at operation to determine the capacity of US to predict ulceration. All of the arteries demonstrated visible ulceration, but only six (20.7 per cent) were predicted by US. The deepest ulcerations that were not detected by US were 2 millimeters in depth. US images were unsatisfactory in 44 arteries (3.7 per cent) because of excessive sound reflection and in 60 (5.0 per cent) because of a "high bifurcation." We conclude that Doppler periorbital flow studies are not as accurate as carotid sonography nor do they add to the accuracy of sonography when the two examinations are combined. Sonography identified significant stenoses but failed to grade the stenoses well and was unreliable in detecting shallow to moderately deep ulcerations.