Introduction

The clear relationship between disease of the carotid bifurcation, transient ischemic attacks and strokes has been known for a considerable amount of time (Roederer et al., 1984; Clinical Advisory, 1994; NASCET, 1991; ECACAS, 1995). The debates that have emerged over the 1980s have centred largely on how to detect it and how and when it should be treated. While the development of contrast arteriography clarified to some degree what we needed to know, it had and has terrible shortcomings. There is no question about its potential for harm but, most importantly, its limitations as a ‘gold standard’ are now being realized. This form of testing has had some very interesting twists which need to be commented on (ECACAS, 1995; Chikos et al., 1983; Davies & Humphrey, 1993).

The desired form of imaging for many years was obtained by using cut-film, multiple views of the bulb, a look at the arch of the aorta and the intracranial circulation as well. This began to change when the digital techniques became popular, along with the rapid rise and fall of intravenous angiography. Suddenly, many of the standard views which were deemed necessary were no longer important or did not seem so. There is no evidence that the therapy of carotid artery disease – medical or surgical – suffered by this change in approach and attitude on the part of the physicians.