Carotid colour Doppler imaging is now available in many district general hospitals. However, there are often long waiting lists during which time patients are at their greatest risk of a major stroke. Mead et al (this volume, pp 16-19) have analysed the Doppler results in 726 patients who had had a carotid transient ischaemic attack or minor stroke in an attempt to define those clinical criteria which could be used to identify patients most likely to have a carotid stenosis of 70-99%.

Although ipsilateral bruit is the best predictor, in isolation it identified only about 50% of all carotid stenoses. The presence of any three of ipsilateral bruit, diabetes mellitus, previous transient ischaemic attack, and absence of lacunar syndrome improved the specificity to 97% but reduced the sensitivity to only 17%. The presence of one or more of these four factors increased the sensitivity to 99% but reduced the specificity to . . . [Full text of this article]