title: Mandatory diagnostic angiography for carotid artery stenosis prior to carotid artery intervention.
abstract: BACKGROUND
  Revascularization is an important strategy for reducing stroke risk in patients with severe carotid atherosclerosis. Magnetic resonance angiography (MRA) and/or carotid ultrasound have traditionally been used as the only diagnostic modalities prior to revascularization. Patients undergoing CEA frequently have no further assessments of carotid anatomy prior to surgery. Evaluation with carotid ultrasound and MRA can often overestimate the degree of stenosis. We sought to determine if noninvasive imaging was sufficient for determining whether a patient should be referred for carotid intervention.
  
  
  METHODS
  We performed an analysis of 101 patients referred for carotid artery stenting (CAS). All patients had previously been evaluated with carotid ultrasound and 94% had undergone MRA as well. We sought to determine if noninvasive diagnostic imaging for carotid stenosis was sufficient to determine the necessity for endovascular intervention.
  
  
  RESULTS
  Of the 101 patients referred for carotid intervention, 36 (36%) were shown to have <70% stenoses and did not require intervention. Of those who had significant disease, 49 (75%) underwent successful CAS, 15 (23%) underwent CEA, and 1 patient was treated medically for a total occlusion. Three of the 36 patients not requiring carotid intervention were found to have subclavian stenosis. Two (4%) of the patients undergoing CAS and 4 (27%) of the patients undergoing CEA had minor complications. No patients suffered a major stroke, MI, or death at follow-up.
  
  
  CONCLUSIONS
  This analysis demonstrates that 36% of patients referred for endovascular intervention based on noninvasive imaging did not meet criteria by angiography. This emphasizes the need for carotid angiography prior to carotid intervention.
authors.affiliation: North Shore University Hospital, Manhasset, New York, New York 11030, USA.
authors.forename: Amgad N
authors.initials: AN
authors.lastname: Makaryus
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Phillips
authors.forename: Paul
authors.initials: P
authors.lastname: Wright
authors.forename: Jason
authors.initials: J
authors.lastname: Freeman
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Green
authors.forename: Lawrence
authors.initials: L
authors.lastname: Ong
authors.forename: Donna
authors.initials: D
authors.lastname: Marchant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology*; D016893:Carotid Stenosis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D015607:Stents; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D014463:Ultrasonography