Carotid endarterectomy without angiography does not compromise operative outcome (original) (raw)

Objectives: carotid angzography zs associated wzth a 2% rtsk of stroke and, since the advent of colour-duplex ultrasound, zts role in the assessment of patwnts with carotid disease has been the subject of debate. The azm of this study zoas to evaluate a pohcy of adopting routine duplex supplemented by selective angzography on operatzve outcome over a 5-year pemod. Methods: a prospect:re audit of the results of carotid endarterectomy without routine angmgraphy from January 1992 to December 1996. Angiography was performed only if the ultrasonography was concerned about the distal or proximal extent of &sease or to assess suboccluszon. Results: during the study perzod, 494 carotid endarterectomws were performed but only 35 patwnts under:vent carottd ang~ography. The indicattons for angwgraphy were subocclusion/string sign zn 22 patwnts, to assess the limits of proxtmal or &stal disease m 12 and abnormal anatomy in one During the 5-year study perlod the overall perioperatwe death and/ or stroke rate was 4.2%. By 1997, the perzoperattve stroke rate had fallen to 1.3% In no case zn this sertes was the operatzon abandoned due to unexpected findings. Conclusion: although concerns exzst about the precise duplex crzterla for diagnosing a severe stenosis, thzs study has shown that a pohcy of selectzve angiography does not compromzse patzent safety or operabihty and avozds the unnecessary mortahty, morbzd#y and costs assoctated with routine angiography.