The use of direct intra-operative Doppler ultrasonography in carotid thromboendarteriectomy. A prospective study.
Large multicenter studies have recently provided long-term results substantiating the superiority of surgical as compared to conservative treatment for symptomatic and asymptomatic extracranial internal carotid stenoses of more than 70%. These results led to an increase in the frequency of thrombo-endarteriectomies. However, indications are limited by the peri-operative complication rate. This explains the need for intra-operative quality control. The present study compares the standard method of intra-operative quality control in carotid surgery, i.e., intra-operative angiography (IOA), with direct intra-operative Doppler ultrasonography (IDU). Thirty-four patients who underwent carotid thrombo-endarteriectomy (carotid TEA) for a symptomatic (n = 15) or asymptomatic (n = 19) carotid stenosis of more than 70% were submitted to both intra-operative IOA and IDU. The sensitivity and specificity of the two techniques were compared in the light of the intra-operative findings. IDU seems to be superior to IOA in the detection of vasospasm. IOA has a higher sensitivity in demonstrating minisaccules, which, however, are not therapeutically relevant. The other findings obtained with both methods were considered to be of equal value. There were no false negative results by IDU regarding therapeutically relevant findings. We therefore consider it advisable to apply IDU in every case of carotid TEA. IOA should be performed in patients with vessel changes detected by IDU.
Stendel
R
R
Department of Neurosurgery, University Medical Center Benjamin Franklin, Free University of Berlin, Germany.
Hupp
T
T
al Hassan
A A
AA
Brock
M
M
D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity / Q000502:physiology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D002533:Cerebral Angiography; D016894:Endarterectomy, Carotid / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000601:surgery; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation; D017585:Ultrasonography, Doppler, Transcranial / Q000295:instrumentation*