SUMMARY One hundred and eight patients were studied with fluid-Ailed oculoplethysmography and carotid phonoangiography (OPG-CPA) and by arteriography. Thirty-two patients also had "Doppler evaluation" of supraorbital arterial flow. The OPG-CPA correctly predicted the degree of occlusion in 76% of the involved vessels, including the degree of ocdusion of each carotid for each patient (63%). The OPG-CPA identified at least one obstructing carotid lesion in 51 of the 56 (91%) patients with obstructing lesions demonstrated by arteriography. On a per patient basis, which requires that both carotids be correctly assessed, the OPG-CPA had a false negative rate of 9.6% and false positive rate of 50%. The supraorbital artery "Doppler evaluation" had an accuracy rate of 66%, a per patient false negative rate of 50%, and a per patient false positive rate of 12%.The OPG-CPA and supraorbital artery "Doppler evaluation" are adjunctive tests for evaluating patients with cerebral vascular insufficiency and should not, at present, replace arteriography in symptomatic patients or in certain asymptomatic patients.Stroke, Vol 12, No 3, 198! SEVERAL NON-INVASIVE TESTS are now available to aid in the screening for and diagnosis of extracranial cerebrovascular disease. Doppler evaluation of supraorbital artery flow patterns, carotid phonoangiography (CPA) in combination with a type of oculoplethysmography (OPG) are the major non-invasive screening tests now used to detect stenotic lesions of the extracranial carotid system. The authors have tested the thesis that the OPG-CPA and/or the "Doppler evaluation" of the supraorbital arterial flow could help to better select patients for arteriography in evaluation of their carotid artery disease. This report compares the results of OPG-CPA with cerebral arteriography in 108 patients. In order to determine whether the Doppler evaluation of the supraorbital artery flow could improve the diagnostic accuracy of the non-invasive evaluation, the results of the Doppler evaluation were reviewed in 32 patients who had this test in combination with OPG-CPA and cerebral arteriography.
Materials and MethodsFrom January 1, 1978, through April 15, 1979, a total of 259 patients had combined OPG-CPA evaluation using the fluid-filled oculoplethysmography device* developed by Kartchner and McRae.1 ' The patients were referred for evaluation of symptoms suggestive of cerebrovascular insufficiency or for evaluation of an asymptomatic bruit. One hundred and eight of these patients had cerebral arteriography and this group provides the data base for this report. During arteriography, the 4 major cerebral vessels were examined by an aortic arch injection. Selective catheterizations of the common carotids and/or vertebral arteries were performed when necessary to rule out an intracerebral lesion or to delineate a high internal carotid arterial lesion. Indications for arteriography were the presence of symptoms of cerebrovascular ischemia regardless of the results of the OPG-CPA evaluation, or the demonstration of a...