title: The evaluation of symptomatic carotid artery disease. A survey of specialty practices in Rhode Island.
abstract: Severe, symptomatic carotid artery disease is most often diagnosed by conventional cerebral angiography. Noninvasive tests are commonly used to identify candidates for angiography and endarterectomy. The purpose of this study, a mail and telephone survey of academic and community neurologists, neurosurgeons, and vascular surgeons in Rhode Island in 1994, was to determine which noninvasive tests physicians used to evaluate these patients and how the test results were used to select patients for angiography. One hundred (86%) of a possible 116 responses were collected. Seventy-six percent of physicians chose carotid duplex ultrasound as the first diagnostic test, a percentage significantly higher than that for any other test (p < 0.0001). Fourteen percent chose angiography without a prior screening test; 3% chose magnetic resonance angiography (MRA) prior to angiography, 6% chose carotid duplex ultrasound plus MRA prior to angiography, and 1% chose MRA without angiography. The specific noninvasive test results required for angiography referral were surprisingly variable, both within and across the three physician specialties. Vascular surgeons and neurosurgeons were more likely to choose angiography without prior screening tests than were neurologists. In conclusion, the majority of specialty physicians in the state of Rhode Island chose carotid ultrasound as the screening test of choice for the evaluation of a potential endarterectomy candidate. Few responding physicians chose MRA in combination with carotid duplex ultrasound prior to angiography, or MRA prior to angiography or MRA alone. Awareness of the actual practice patterns of specialists may lead to programs of education for physicians to improve practice and patient outcome through more refined use of diagnostic tests prior to angiography or endarterectomy.
authors.affiliation: Department of Neurosciences, University of Rome La Sapienza, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bragoni
authors.forename: E
authors.initials: E
authors.lastname: Feldmann
authors.forename: J
authors.initials: J
authors.lastname: Wilterdink
mesh_terms: D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography / Q000706:statistics & numerical data; D016894:Endarterectomy, Carotid; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data; D009462:Neurology / Q000193:education / Q000706:statistics & numerical data; D009493:Neurosurgery / Q000193:education / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012237:Rhode Island / Q000453:epidemiology; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex / Q000706:statistics & numerical data; D014656:Vascular Surgical Procedures / Q000193:education / Q000706:statistics & numerical data