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Seminars in Neurosurgery 2002; 13(3): 217-228
DOI: 10.1055/s-2002-39817
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Modern Imaging in the Management of Cervical Carotid Stenosis

Randy Bell, Rocco A. Armonda, Patrick Noonan
  • The National Capital Consortium Neurosurgery Program, Walter Reed Army Medical Center, Washington, D.C., and National Naval Medical Center, Bethesda, Maryland
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Publication History

Publication Date:
24 June 2003 (online)

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ABSTRACT

Most carotid artery disease is now imaged noninvasively given the availability of modern neuroimaging techniques. Concordance between noninvasive imaging modalities is sufficient in most cases to allow appropriate patient treatment. However, in the face of discordant noninvasive data where the degree of stenosis and presence of a complete occlusion are in question brachiocephalic angiography is employed. Additionally angiography allows for the morphological delineation of the stenosis, tandem lesions and extent of collateral circulation, and proximal lesions that may account for the patient's symptoms. In the hands of experienced operators using meticulous neuroangiographic techniques, modern catheters, and digital subtraction imaging techniques the risks of angiography are reduced, and the diagnostic or therapeutic benefit is enhanced. Angiography should be employed when lesion morphology is unclear due to discordant noninvasive data, clinical diagnosis is in question, or additional complicating factors are involved (i.e., associated intracranial aneurysms, tandem stenosis, symptomatic posterior circulation stenosis, and proximal origin stenosis of the brachiocephalic vessels).

KEYWORDS

Carotid stenosis - imaging - computed tomographic angiography - magnetic resonance imaging

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