Incidental intracranial vascular pathology in patients investigated for carotid stenosis

The assessment of cervical and cranial carotid arteries for atherosclerotic disease is the second commonest referral for angiography in our neuroradiological department; in 1993 this accounted for approximately 17% of the total cases. This is due to the resurgence of interest in endarterectomy for severe carotid stenosis. Although the degree of stenosis can usually be assessed adequately by duplex Doppler ultrasonography, angiography is still recommended as a preoperative examination. The intracranial vessels are visualised, which we consider important when planning vascular surgery. We present a prospective study of 100 patients referred for angiographic assessment of carotid stenosis. As well as giving information about the carotid bifurcation, angiography showed 9 patients to have aneurysms, 2 arteriovenous malformations and 15 severe intracranial atherosclerosis. We consider these “incidental” findings important for future management and highlight the need for thorough assessment of the intracranial vessels in these patients by angiography.