The changing role of duplex scan in the management of carotid bifurcation disease and endarterectomy.

The development of carotid duplex scanning revolutionized the diagnosis of carotid artery disease. Continued advances in the technology as well as widespread experience with cartoid ultrasound have redefined the role this technology plays in the care of patients with carotid atherosclerosis. Recent clinical trials have shown the efficacy of carotid endarterectomy for both symptomatic and asymptomatic carotid artery stenosis, but benefit was shown at different degrees of stenosis from commonly used duplex diagnostic criteria. Investigators have therefore refined duplex diagnostic criteria to conform with the randomized trials while also redefining the effect of contralateral occlusions. These refined criteria have not only facilitated surgeons' clinical recommendations but allowed the performance of carotid surgery without the risks and expenses of arteriography. In addition, a better understanding of the significance of intraoperative duplex findings and the implications for restenosis has increased the utility of duplex scanning during surgery while decreasing the frequency of postoperative follow-up. Finally, this review discusses a few developing applications of carotid duplex scanning.