Contrast-enhanced 3-D MRA in decision making for carotid endarterectomy: a 6-year experience.
BACKGROUND
Systematic need for angiography in diagnosis of carotid artery stenosis and indication of surgical therapy is still debated. Noninvasive imaging techniques such as MR angiography (MRA) or CT angiography (CTA) offer an alternative to digital subtraction angiography (DSA) and are increasingly used in clinical practice. In this study, we present the radiological characteristics and clinical results of a series of patients operated on the basis of combined ultrasonography (US)/MRA.


METHODS
This observational study included all the patients consecutively operated for a carotid stenosis in our Department from October 1998 to December 2004. The applied MRA protocol had previously been established in a large correlation study with DSA. DSA was used only in case of discordance between US and MRA. The preoperative radiological information furnished by MRA was compared with intraoperative findings. The outcome of the operation was assessed according to ECST criteria.


RESULTS
Among 327 patients, preoperative MRA was performed in 278 (85%), DSA in 44 (13.5%) and CT angiography in 5 (1.5%). Most of DSA studies were performed as emergency for preparation of endovascular therapy or for reasons other than carotid stenosis. Eleven additional DSA (3.3%) complemented US/MRA, mostly because diverging diagnosis of subocclusion of ICA. No direct morbidity or intraoperative difficulty was related to preoperative MRA. Combined mortality/major morbidity rate was 0.9% (3 patients) and minor morbidity rate 5.5% (18 patients).


CONCLUSIONS
This observational study describes a well-established practice of carotid surgery and supports the exclusive use of non invasive diagnostic imaging for indicating and deciding the operation.
Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland. alain.barth@insel.ch
Alain
A
Barth
Marcel
M
Arnold
Heinrich P
HP
Mattle
Gerhard
G
Schroth
Luca
L
Remonda
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D003287:Contrast Media; D003657:Decision Making; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D009942:Organometallic Compounds; D018579:Patient Selection; D016896:Treatment Outcome
D003287:Contrast Media; D009942:Organometallic Compounds; C090600:gadobutrol