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Some recent studies of noninvasive carotid imaging have identified high rates of inappropriate decision-making about endarterectomy compared with conventional arterial angiography (CAA), but there is substantial inconsistency across the published literature. CAA is usually regarded as the gold standard for carotid imaging, partly because the degree of angiographic stenosis is a powerful predictor of ischemic stroke and hence of benefit from endarterectomy. However, there are very few published data on the extent to which predictive power varies with type of CAA or the number and quality of views of the stenosis obtained.

Effect of Nonoptimal Imaging on the Relationship Between the Measured Degree of Symptomatic Carotid Stenosis and Risk of Ischemic Stroke