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Duplex ultrasonography is almost as accurate and can additionally analyse plaque morphology. Of 2651 duplex tests carried out in our laboratory. 12.2% were for reversible ischaemic attacks, 2.7% for amaurosis, 12.1% for cervical bruit and 4.3% for vertebrobasilar ischaemia. Duplex within 30 days of operation was carried out on 607 patients (22.9%) and surveillance on 1000 others (37.7%). Asymptomatic carotid stenosis &gt;60% should be confirmed by intra-arterial digitial subtraction angiography, magnetic resonance angiography or spiral computed tomography angiography. For typical transient ischaemic attacks, duplex or angiography alone is adequate but when the clinical presentation is atypical, a confirming test is required. Routine preoperative brain computed tomography is not cost-effective, being equivalent to US$ 4300\u201311 840 per perioperative stroke in our institution. 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