title: Carotid arteriography impacts carotid stenosis management.
abstract: Recent literature advocates carotid endarterectomy on duplex alone. The authors hypothesized that carotid angiography adds information that alters clinical management in a substantial number of patients compared to the use of carotid duplex examination alone. The records of 182 consecutive patients who underwent carotid artery duplex and subsequent carotid/cerebral angiography for suspected carotid artery stenosis between January 1998 and April 1999 were reviewed retrospectively. Carotid artery duplex examinations were stratified based on stenosis: < or =39%, 40% to 59%, 60% to 79% (moderate), 80% to 99% (severe), 100%. Carotid stenosis on angiograms was determined by NASCET criteria. New information found at angiography included vertebral, subclavian, or arch atherosclerosis, intracranial pathosis, or a change in duplex stenosis category to a degree of stenosis not requiring surgery. Clinical importance was attributed to angiograms that altered the patients' management plan. Angiography provided additional information in 53% (97/182) of patients. Vertebral disease was found in 25.1%, subclavian disease in 16.4%, intracranial disease in 15.3%, aortic arch disease in 3.3%. Patient treatment was altered in 30% (55/182). Angiographic findings downgraded the stenosis to medical therapy in 20.9% (38/182). The surgical plan was influenced in 5.5% (10/182). Nine intracranial aneurysms were discovered. Carotid angiography was essential for vascular bypass surgery planning in 3.3% (6/182). Angioplasty was performed in 2.2% (4/182). The accurate determination of stenosis is critical in determining optimal treatment of patients with carotid artery stenosis. Routine carotid angiography remains valuable in the clinical treatment of these patients.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Long
authors.forename: J A
authors.initials: JA
authors.lastname: Kern
authors.forename: S M
authors.initials: SM
authors.lastname: Fiser
authors.forename: A K
authors.initials: AK
authors.lastname: Kaza
authors.forename: D C
authors.initials: DC
authors.lastname: Cassada
authors.forename: B T
authors.initials: BT
authors.lastname: Miller
authors.forename: J A
authors.initials: JA
authors.lastname: Claridge
authors.forename: I L
authors.initials: IL
authors.lastname: Kron
authors.forename: C G
authors.initials: CG
authors.lastname: Tribble
mesh_terms: D000368:Aged; D000792:Angiography; D000800:Angioplasty, Balloon; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000628:therapy; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis; D008297:Male; D018616:Ultrasonography, Doppler, Duplex