[Value of X-ray computed tomography of the brain in controlled carotid surgery]

The usefulness of computerized tomography (CT) in elective carotid surgery was evaluated in a prospective study of 402 patients who had a surgical operation on one or two atheromatous arteries and were explored by pre and post-operative CT of the brain. Pre-operative CT scans revealed an ischaemic lesion in 22 per cent of asymptomatic patients and in 29 per cent of patients who had experienced a transient ischaemic accident. Abnormal pre-operative CT scans were associated with a statistically significant increase in per-operative electroencephalographic changes, but there was no significant increase in post-operative neurological complications. Post-operative CT scans showed a "silent" infarct in 6 per cent of the cases; 59 per cent of patients with neurological complications had normal or unchanged post-operative CT images. This study suggests that pre-operative CT is not necessary to evaluate the neurological risk and that post-operative CT alone is inadequate to quantify the morbidity of carotid surgery.