BACKGROUND AND OBJECTIVES: Intracranial atherosclerosis causes 8-10% of strokes in North America and 30-50% of strokes in studies done in Asia. 1 Aware of these differences and the financial burden it can bring, diagnostic tests should be prudently chosen to economize and obtain high-yield positive results. The aim of this study is to determine the prevalence of intracranial and extracranial disease among patients who developed ischemic stroke or transient ischemic attack (TIA) using transcranial Doppler (TCD) and carotid duplex scan (CDS). Additionally, we aim to determine the cost-effectiveness of each diagnostic test among 100 hypothetical stroke subjects undergoing each test.

METHODS: Participants were 442 men and women who had ischemic stroke or transient ischemic attack. The prevalence of intracranial stenosis and extracranial stenosis was determined by transcranial Doppler study and carotid duplex study respectively. The cost-effectiveness was computed by multiplying the prevalences by the estimated cost of each procedure.

RESULTS: The prevalence of symptomatic intracranial carotid stenosis in our hospital is 26% while that of extracranial carotid disease is 3.6%. In 100 hypothetical cases, 26 will turned out positive for intracranial stenosis using TCD while only 4 will turn out positive for extracranial stenosis using CDS.

CONCLUSION: In our setting, TCD is a cost-effective test and must be included in the initial diagnostic and treatment strategy for patients with ischemic stroke or transient ischemic attack.