The superiority of combined continuous wave Doppler examination over periorbital Doppler for the detection of extracranial carotid disease.

Non-invasive examination of 431 vessels in 333 patients with cerebrovascular disease in all stages was performed in order to compare the reliability of the periorbital Doppler test alone and together with the more difficult insonation of the carotid arteries in the neck (combined Doppler). These findings were compared with those of subsequent arteriography. Extracranial obstructive (greater than 50%) carotid disease was detected with 100% sensitivity by the combined Doppler, but with only 48% sensitivity by the periorbital indirect test. The specific ability of both methods to identify non-stenotic carotid arteries (less than 50%) was similar at about 98%. Only the combined Doppler examination reliably differentiated various degrees of obstruction, comparable to that obtained with arteriography. Non-obstructive plaques could not be detected or excluded by either Doppler test. More refined methods will be necessary for their evaluation.