title: Carotid surgery without angiography is possible and safe.
abstract: BACKGROUND
  To evaluate the possibility to perform carotid surgery without angiography.
  
  
  METHODS
  From January 1994 to June 1998, 514 patients with carotid obstructive disease were operated upon, 225 of them (43.8%) without previous angiography; 55 out of 68 (80.8%) during the last six months. Eighty-one (36.0%) had lateralizing symptoms, 50 aspecific ones (22.2%) and 94 were asymptomatic (41.8%). All patients were investigated by color-coded duplex sonography (CDS) of the arteries at the neck and by transcranial Doppler (TCD) and computed tomography (CT). One hundred eighty-eight patients were operated upon under local anaesthesia and 37 under general anesthesia; 204 had a carotid endartereotomy (90.7%) with patch angioplasty in 154 (75.5%), and 21 required a bypass graft (9.3%). In 26 patients (11.5%) an indwelling shunt was needed.
  
  
  RESULTS
  Findings at surgery were consistent with CDS for plaque composition, ulcerations and degree of stenosis. There were no early deaths. Neurologic or ocular deficits occurred in 2 cases (0.9%). No strokes were observed in follow-up from 6 to 34 months.
  
  
  CONCLUSIONS
  Carotid endarterectomy can be done without angiography in selected cases provided CDS plus TCD are of high quality. Under such conditions it can be considered a safer way to deal with carotid obstructive disease.
authors.affiliation: 2nd Chair of Vascular Surgery, University La Sapienza, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Benedetti-Valentini
authors.forename: B
authors.initials: B
authors.lastname: Gossetti
authors.forename: L
authors.initials: L
authors.lastname: Irace
authors.forename: F
authors.initials: F
authors.lastname: Intrieri
authors.forename: O
authors.initials: O
authors.lastname: Martinelli
authors.forename: E
authors.initials: E
authors.lastname: Trenti
authors.forename: R
authors.initials: R
authors.lastname: Stumpo
authors.forename: P
authors.initials: P
authors.lastname: Costa
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018615:Ultrasonography, Doppler, Color; D018616:Ultrasonography, Doppler, Duplex; D017585:Ultrasonography, Doppler, Transcranial