Comments, Opinions and Reviews Carotid Artery Noninvasive Testing is Being Overused

The most frequent tests done in the evaluation of patients with potential cerebrovascular disease are Oculoplethysmography (OPG) and Imaging procedures. These procedures are useful in the evaluation of asymptomatic carotid bruits and may be helpful in evaluating patients with nonhemispheric symptoms. However, there is no reasonable indication for the use of these noninvasive procedures on patients with lateralizing hemispheric or ocular transient ischemic attacks. Lateralizihg transient ischemic attacks are very often caused by ulcerated non-stenosing lesions which are easily missed by these noninvasive means. Arteriography is mandatory in this group whenever the patient is a potential surgical candidate should an appropriate lesion be found. Finally, progress made in bruit analysis is acknowledged but the clinical relevance of this datum is questioned.