Clinical presentation of suspected carotid artery disease. Screening of candidates for arteriography with the assistance of the vascular laboratory

The evaluation of suspected carotid artery disease was reviewed in a consecutive series of 292 patients referred by attending physicians in a university hospital. Twenty-three percent of the patients with classical transient ischemic attacks, and all those suitable for eventual surgery were recommended for arteriography. In 75% of the patients the presenting symptoms were nonlateralizing or equivocal. In this group the results of nonivasive vascular tests were decisive as to the recommendation for arteriography, which was positive in 79% of those performed. Among 100 surveyed patients who did not undergo arteriography, cerebrovascular accidents occurred in 3 patients: carotid disease was detected in 2 of them, in whom arteriography had been postponed for clinical reasons, while in the third a subsequent arteriography demonstrated no carotid lesion. Expert clinical assessment assisted by vascular studies prevented unnecessary arteriography in 62% and detected carotid pathology with atypical presentation in 13% of the patients.