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Perioperative Imaging Strategies for Carotid Endarterectomy:Analysis of Morbidity & Cost-Effectiveness in Symptomatic Patients
JAMA 274:888-893, Kent,K.C.,et al, 1995
See this aricle in Pubmed

Article Abstract
To assess the cost-effectiveness of four diagnostic strategies for the preoperative evaluation of symptomatic patients who are potential candidates for carotid endarterectomy(ie,70%to 99%stenosis):(1)duplex sonography(DS),(2)magnetic resonance angiography(MRA),(3)contrast angiography(CA),and(4)the combination of DS and MRA supplemented by CA for disparate results.Our results suggest that for the preoperative detection of a 70%to 99%carotid stenosis,the combination of DS and MRA,supplemented by CA for disparate results,is associated with the lowest long-term morbidity and mortality and has a favorable cost-effectiveness ratio.The combination of tests,or DS alone when MRA is not available,could potentially replace the current practice of using CA alone in the preoperative evaluation of patients with symptomatic carotid stenosis.
 
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