Intraoperative arteriography and carotid surgery

To minimize morbidity in carotid surgery we have adopted the practice of routine operative arteriography. In our total experience of 692 carotid artery reconstructions done since 1979 no arteriography was used for the first 157 procedures. The combined morbidity and mortality rate in this group was 4.5% (4 strokes and 3 deaths as a result of stroke). After 157 carotid operations we used intraoperative arteriography on all cases, and the neurologic morbidity and mortality rate for this part of the series was 1.3% (6 strokes and 1 fatal cerebral hemorrhage). One death was due to myocardial infarction. The difference in ischemic neurologic sequellae between these two groups was statistically significant by chi-square analysis (p less than 0.01). Although the difference in these two cohorts could be related to the "learning curve" effect, it is unlikely that this is the only reason for the difference. Intraoperative arteriography has demonstrated unsuspected stenoses, occlusions, flaps, and kinks. There was also a statistically significant difference (p less than 0.01) in the number of reoperations for recurrent stenosis: 3.8% in the first group and 0.8% in the second group. No complications were thought to be directly associated with the arteriogram. Since the development of better digital imaging systems for the operating suite, this technique is much more easily used than when it was first described.