For asymptomatic patients, advances in medical therapy have rendered data from older clinical trials on the benefit of endarterectomy out of date, and thus the value of determining the degree of stenosis in these patients is less clear and currently the subject of a large randomized clinical trial [108- 110]. Currently, guidelines from professional societies continue to recommend CEA for certain selected patients with asymptomatic stenosis in which the degree of stenosis is an important deciding factor [111,112]. Arteriography Cervicocerebral Catheter-directed cerebral angiography has the highest spatial resolution and temporal resolution of any vascular study. Catheter-directed angiography is the most accurate means of delineating the degree of vascular stenosis and can also be useful in the evaluation of collateral circulation. However, the usefulness of this technique for screening is obviated by the invasive nature of the examination. Moreover, there is no literature supporting cerebral angiography as the initial imaging test in evaluation of a carotid bruit. Nonetheless, cerebral angiography may be necessary in some cases after the initial diagnosis of hemodynamically significant carotid stenosis is made on noninvasive imaging. CT Head Perfusion With IV Contrast CT head perfusion imaging may help delineate the hemodynamic significance of a known carotid lesion and the collateral support in each distribution. However, there is no literature to support the use of CTP for the initial detection of hemodynamically significant carotid disease in the asymptomatic patient with a carotid bruit. CT Head With IV Contrast There is no relevant literature to support the use of contrast-enhanced CT of the head in the evaluation of the asymptomatic patient with a carotid bruit. Cerebrovascular Diseases-Stroke
Cerebrovascular Diseases Stroke and Stroke Related Conditions PCAs. For asymptomatic patients, advances in medical therapy have rendered data from older clinical trials on the benefit of endarterectomy out of date, and thus the value of determining the degree of stenosis in these patients is less clear and currently the subject of a large randomized clinical trial [108- 110]. Currently, guidelines from professional societies continue to recommend CEA for certain selected patients with asymptomatic stenosis in which the degree of stenosis is an important deciding factor [111,112]. Arteriography Cervicocerebral Catheter-directed cerebral angiography has the highest spatial resolution and temporal resolution of any vascular study. Catheter-directed angiography is the most accurate means of delineating the degree of vascular stenosis and can also be useful in the evaluation of collateral circulation. However, the usefulness of this technique for screening is obviated by the invasive nature of the examination. Moreover, there is no literature supporting cerebral angiography as the initial imaging test in evaluation of a carotid bruit. Nonetheless, cerebral angiography may be necessary in some cases after the initial diagnosis of hemodynamically significant carotid stenosis is made on noninvasive imaging. CT Head Perfusion With IV Contrast CT head perfusion imaging may help delineate the hemodynamic significance of a known carotid lesion and the collateral support in each distribution. However, there is no literature to support the use of CTP for the initial detection of hemodynamically significant carotid disease in the asymptomatic patient with a carotid bruit. CT Head With IV Contrast There is no relevant literature to support the use of contrast-enhanced CT of the head in the evaluation of the asymptomatic patient with a carotid bruit. Cerebrovascular Diseases-Stroke