Noninvasive methods for evaluation of extracranial cerebrovascular disease. A comparison.

Sixty-five patients with clinical evidence of carotid occlusive disease were evaluated by the Doppler ophthalamic test, ophthalmodynamography, and oculopneumoplethysmography prior to angiography. Clinical assessment was accurate 68% of the time, with 32% of patients having no arteriographic evidence of significant disease. The sensitivity of the noninvasive tests was dependent on the extent of the carotid stenosis. When the extent was greater than 60% of the cross-sectional diameter, the Doppler ophthalmic test was accurate 54% of the time; the ophthalmodynamography test, 61% of the time; and the oculopneumoplethysmographic test, 97% of the time. In lesions encompassing 50% to 60% of the vessel diameter, the Doppler ophthalmic test was accurate 15% of the time; the ophthalmodynamography test, 17% of the time; and the oculopneumoplethysmographic test, 10% of the time. With less than 50% stenosis, none of the noninvasive tests detected atherosclerotic lesions. Although many diseased vessels were missed, the low incidence of false-positive tests enhanced the usefulness of these methods in augmenting the accuracy of clinical evaluation.