Carotid Stenosis: Utility of Diagnostic Angiography

Carotid artery stenosis is frequently diagnosed through screening tests with noninvasive imaging. Because of differences noted between the various modalities, we sought to investigate our experience comparing noninvasive imaging (ultrasound, computed tomography angiography, magnetic resonance angiography) with invasive imaging (digital subtraction angiography). In a multicenter retrospective analysis, 249 carotid vessels were reviewed based on angiography with the associated noninvasive imaging. Overall, medical or surgical decision management was changed in 43% (107/243) of cases investigated with digital subtraction angiography owing to a discrepancy between the measured percentage stenosis. In patients with potentially treatable carotid stenosis, angiography revealed nonsignificant stenosis 25.7% of the time. Angiography should be considered the confirmatory test for degree of stenosis in certain patients before definitive surgical treatment.