Carotid endarterectomy without angiography: can clinical evaluation and duplex ultrasonographic scanning alone replace traditional arteriography for carotid surgery workup? A prospective study.
BACKGROUND
The aim of this study was to determine whether clinical evaluation and duplex ultrasonography (DUS) alone can replace contrast cerebral arteriography (CA) for the detection of patients suitable for surgery at our institution.


METHODS
During an 18-month period, 100 patients underwent DUS and CA during evaluation for carotid endarterectomy (CEA). All patients were studied prospectively; in each case an initial decision for or against CEA on the basis of DUS evaluation of the internal carotid arteries (ICAs) was subsequently compared with the surgeon's final management plan after CA. Of the 200 ICAs evaluated, 113 were considered for CEA but 14 were excluded from the study because the patient could not be evaluated before and after CA. This left 99 ICAs (86 patients) available for comparative analysis.


RESULTS
The outcome of the 2 diagnostic modalities was perfectly consistent in 95.3% of the ICAs (kappa = 0.969). The clinical management decision was altered by the CA findings in only 2 cases (2%). Of the 99 ICAs considered suitable, 97 underwent CEA. No arteriographic complications occurred among the 100 patients undergoing CA. The perioperative stroke risk and mortality rates were 0%.


CONCLUSIONS
Ninety-eight percent of the ICAs considered for surgery would have received appropriate clinical treatment on the strength of the patients' neurologic history and the outcome of DUS alone. Our results indicate that DUS is sufficient to establish the need for surgery in symptomatic and asymptomatic patients being considered for CEA and can replace CA in most clinical circumstances.
Department of Medical and Surgical Sciences, University of Padua, School of Medicine, Italy.
E
E
Ballotta
G
G
Da Giau
E
E
Abbruzzese
M
M
Saladini
L
L
Renon
G
G
Scannapieco
G
G
Meneghetti
D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000401:mortality; D016894:Endarterectomy, Carotid; D006801:Humans; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D018616:Ultrasonography, Doppler, Duplex