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Carotid surgery without angiography is possible and safe.
F Benedetti-Valentini1, B Gossetti, L Irace
12nd Chair of Vascular Surgery, University La Sapienza, Rome, Italy.
The Journal of Cardiovascular Surgery
|October 29, 2000
Summary
Carotid surgery is feasible without angiography in select patients. High-quality color-coded duplex sonography (CDS) and transcranial Doppler (TCD) enable safe carotid endarterectomy, reducing risks.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Evaluating the feasibility of performing carotid surgery without traditional angiography.
- Assessing alternative diagnostic methods for carotid obstructive disease.
Purpose of the Study:
- To determine if carotid endarterectomy can be safely performed without pre-operative angiography.
- To establish the role of non-invasive imaging in patient selection for carotid surgery.
Main Methods:
- 514 patients with carotid obstructive disease underwent surgery; 225 (43.8%) without prior angiography.
- Pre-operative assessment included color-coded duplex sonography (CDS), transcranial Doppler (TCD), and computed tomography (CT).
- Surgical procedures included carotid endarterectomy (90.7%) with patch angioplasty or bypass graft, under local or general anesthesia.
Main Results:
- Surgical findings correlated well with CDS for plaque characteristics and stenosis.
- No early deaths occurred; neurologic or ocular deficits were observed in only 2 cases (0.9%).
- Follow-up of 6 to 34 months revealed no strokes.
Conclusions:
- Carotid endarterectomy can be safely performed in selected patients without angiography.
- High-quality CDS and TCD are crucial for accurate diagnosis and patient selection.
- This approach may represent a safer method for managing carotid obstructive disease.