We compared the results of cerebral angiography, transcranial Doppler ultrasonography of the middle cerebral artery and oculopneumoplethysmography in 35 subjects. The subjects included eight with normal cerebral arteriograms and 27 with varying degrees of internal carotid stenosis. We found a statistically significant (P = .0001) decreasing linear trend in the middle cerebral artery flow acceleration as a function of the degree of internal carotid artery stenosis. We also observed a decreasing trend in oculopneumoplethysmography (P = .0004) as a function of the degree of internal carotid stenosis. This latter relationship was enhanced with the addition of a quadratic term in the regression model (P = .02). We also found that there was a statistically significant reduction in the flow acceleration, on average, when comparing carotid stenosis of 75 to 100% to lesser degrees of stenosis (P = .0001). This was also the case for oculopneumoplethysmography (P less than .02). The flow acceleration and oculopneumoplethysmography appear to be relatively sensitive indicators of the distal hemodynamic effect of internal carotid artery stenosis.