Examination of 88 extracranial carotid arteries using CW Doppler spectrum analysis is compared with the findings of transfemoral conventional arteriography. There is no significant difference (P greater than 0.05) between CWD and angiographic results, although sensitivity, specificity and accuracy are superior for the latter technique. CWD spectrum analysis can underestimate complete occlusion and misinterpret the degree of stenosis, however it is a cheap and rapid procedure that can be used to judge whether particular symptoms are due to identifiable disease and whether selective carotid arteriography is advisable.