Atherosclerosis of the cervico-cerebral arteries is a generalized disease which frequently involves the whole carotid system. The bifurcations (48.7%), the proximal 2 cms. of the internal carotid arteries (61.6%) and the carotid siphons (60.3%) are most frequently affected. Angiography may demonstrate ulcerated lesions in up to 25% of cases. "Tandem stenoses" in both the extracranial segments of the carotid arteries (4.6%) and isolated hemodynamically significant stenoses in the carotid siphons (.7%) are uncommon. Nevertheless their presence may play an essential role in therapeutical decision making. Because of the multiplicity of lesions, the claim for preoperative selective arteriography is justified. IA DSA may replace film angiography, if image quality and medical information are identical. IV DSA and Doppler-procedures as a rule cannot replace selective arteriography in preoperative work-up.
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