Carotid surgery without arteriography: noninvasive selection of patients.
All carotid noninvasive studies at our institution comprised of duplex scanning, spectral frequency analysis, and ocular-pneumoplethysmography-Gee supraorbital Doppler assessments from 1985-1987 were reviewed. Forty symptomatic and 104 asymptomatic internal carotid arteries, concomitantly studied noninvasively and arteriographically, were identified. All studies were rereviewed prospectively and in blinded fashion. Utilizing peak frequency--internal carotid artery greater than 10 mHz and carotid index (Pf-ICA)/PF-common carotid) greater than 5 as criteria for surgery, 39/40 symptomatic internal carotid arteries were considered appropriate for carotid endarterectomy by noninvasive study. All of these internal carotid arteries had arteriographic confirmation of greater than 50% internal carotid artery stenosis; 22 of them met noninvasive criteria for surgery of peak systolic frequency-internal carotid artery greater than 14 mHz, carotid index greater than 7 and abnormal ocular-pneumoplethysmography-Gee/supraorbital Doppler. All of these had arteriographic confirmation of greater than 80% internal carotid artery stenosis. Eleven asymptomatic internal carotid arteries met spectral frequency criteria for carotid endarterectomy but had normal ocular-pneumoplethysmography-Gee/supraorbital Doppler. Eight in this group had less than 80% stenosis on arteriographic exam. Carotid endarterectomy may be performed without prior arteriography, provided objective criteria are established in a reliable noninvasive lab and met by individual patients.
Gertler
J P
JP
Division of Vascular Surgery, Massachusetts General Hospital, Boston.
Cambria
R P
RP
Kistler
J P
JP
Geller
S C
SC
MacDonald
N R
NR
Brewster
D C
DC
Abbott
W M
WM
D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000601:surgery; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging* / Q000601:surgery*; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D010991:Plethysmography / Q000379:methods; D011446:Prospective Studies; D011859:Radiography; D014463:Ultrasonography