Comparison of noninvasive diagnostic techniques in carotid artery occlusive disease

In an effort to establish a reliable laboratory screening device for detection of significant interval artery stenosis, 513 patients were examined by three noninvasive techniques (supraorbital artery directional flow detection, fluid-filled oculoplethysmography with phonoangiography, and pneumo-oculoplethysmography). One hundred and forty-three patients underwent cerebral arteriography and the arteriographic findings were correlated with the results of these three tests. Of 80 patients (160 carotid arteries) examined by the Doppler technique, flow reversal in the supraorbital artery was seen in 59% of patients with luminal stenosis of greater than 75% of the diameter. Of 37 patients (74 arteries) evaluated by pneumo-oculoplethysmography, ophthalmic artery pressure measurement was accurate in 31%. Through use of the combination of fluid-filled oculoplethysmography and phonoangiography in 143 patients (286 arteries), either phase-delay of the ocular or a bruit displayed by phonoangiography was found to be 89.5% accurate in predicting angiographic stenosis. The ease of performance, lack of complications, and the high diagnostic accuracy of fluid-filled oculoplethysmography and phonoangiography make it a satisfactory laboratory screening test. Such a test is of particular value in patients presenting with dizziness or vague cerebrovascular symptoms. All of these flow-dependent tests, however, fail to detect ulcerating plaques causing focal hemispheric or eye symptoms unless accompanied by significant stenosis.