Modalities of preoperative imaging of the internal carotid artery used in France.
A survey of the 382 members of the Société de Chirurgie Vasculaire de Langue Française was conducted to determine preferred imaging techniques for preoperative assessment of the proximal internal carotid artery. A total of 180 questionnaires were returned concerning 9390 carotid stenoses treated in the year 2000. Doppler ultrasound (DUS), angiography, magnetic resonance angiography (MRA), and computed tomography angiography (CTA) were routinely used in 99%, 51.5%, 4%, and 3% of cases. Usual work-up methods involved DUS and angiography in 64% of cases, DUS and MRA in 7%, and DUS and CTA in 4% of cases. Indications for endarterectomy were based on DUS and angiography findings in 69% of cases, on DUS and MRA findings in 14%, on DUS and CTA findings in 9%, and on DUS findings alone in 8%. In-house access to CTA or MRA was more frequent at state-run institutions (p = 0.00001). Indication of endarterectomy based on DUS and MRA was more common at institutions equipped with technical facilities for MRA (21% vs. 8%; p = 0.001). An inverse correlation was observed between the number of carotid artery procedures performed and use of DUS and angiography work-up. The number of carotid endarterectomies without angiography is increasing in France. Preoperative DUS is still routinely used. Combined DUS and MRA is the preferred work-up for endarterectomy without angiography. Lack of access to MRA is still a limiting factor. Further study will be needed to evaluate the benefits and risks of endarterectomy without angiography.
Long
Anne
A
Service de Radiologie Cardiovasculaire, Hôpital Européen George Pompidou, Paris, France.
Lepoutre
Agnès
A
Corbillon
Emmanuel
E
Branchereau
Alain
A
Kretz
Jean-Georges
JG
D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000601:surgery; D003952:Diagnostic Imaging / Q000706:statistics & numerical data*; D016894:Endarterectomy, Carotid; D005602:France; D006801:Humans; D018810:Magnetic Resonance Angiography; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed; D018608:Ultrasonography, Doppler