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Investigation

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Several investigations are available to evaluate carotid stenosis.

  • duplex doppler ultrasonography
    • usually the first diagnostic imaging method used
    • detects calcification of carotid-artery plaque and intraplaque hemorrhage and can measure the degree of stenosis
    • relatively inexpensive and non invasive
    • has a sensitivity of 86% and a specificity of 87% for the detection of hemodynamically significant carotid artery stenosis
  • computed tomographic angiography
    • provides good resolution of entire vascular tree - the carotid arteries from the aortic arch to the circle of Willis with 100% sensitivity and 63% specificity
  • magnetic resonance angiography
  • catheter angiography (1,2,3)

Other investigations should be for vascular risk factors and other causes of stroke - FBC, ESR, U+E's, blood sugar, serum cholesterol, serology for syphilis, ECG and CXR. Echocardiography to exclude a cardiac source of embolism or a CT in patients with TIA to exclude an intracranial lesion, may be warranted.

Carotid and vertebral angiography should be used only to confirm the results of non-invasive screening and to determine the degree of stenosis for possible surgery.

Reference:

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