Carotid endarterectomy without angiography.

Three patients with unilateral hemispheric symptoms suggestive of extracranial carotid occlusive disease and one patient with bilateral symptoms who were allergic to radiographic contrast media were studied by pulsed Doppler ultrasonic arteriography and real time spectrum analysis. Four high grade (greater than 50% diameter reduction) internal carotid stenoses and one low grade (less than 50% diameter reduction) stenosis were identified. The noninvasive findings were confirmed at endarterectomy in all five arteries. Pulsed Doppler ultrasonic imaging combined with real time spectrum analysis can accurately quantitate the degree of atherosclerotic stenosis at the carotid bifurcation. Experience with these four patients suggests that these techniques can be used in lieu of angiography to evaluate patients who are unable to undergo standard radiographic examination.