Duplex scanning and periorbital pulsed Doppler in the diagnosis of external carotid artery disease: analysis of causes of error.

The external carotid arteries (ECA) were examined by duplex scanning in 123 consecutive patients with transient ischaemic attacks (TIA) and minor stroke. Two occlusions and five out of six high grade stenosis were correctly classified, yielding a sensitivity of 88% defining disease as stenosis greater than 50. Specificity was 94% and accuracy was 93%. Nine low grade stenosis (less than 50%) and six normal vessels were judged as high grade stenosis. A possible cause of this overestimation was a compensatory flow increase in the ECA caused by an occlusion or high grade stenosis in the internal carotid arteries (ICA), either on the same side or bilaterally. This was supported by the finding of a significantly (P less than 0.05) higher retrograde flow velocity in the ipsilateral supratrochlear arteries (STA) in patients with high ECA flow velocity, as compared to those with normal ECA flow. Thus in the evaluation of a possible ECA stenosis, the condition of the ICA should be considered in order to avoid overestimation of ECA lesions. The additional examination of flow direction and velocity in STA gives an indication as to whether or not an ECA stenosis might be present.