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Carotid endarterectomy based on duplex scanning without preoperative arteriography
W G Marshall1, N T Kouchoukos, S F Murphy
1Division of Cardiovascular and Thoracic Surgery, Jewish Hospital, Washington University Medical Center, St. Louis, MO 63110.
Circulation
|September 1, 1988
Summary
Duplex scanning accurately identifies carotid artery disease, offering a safe alternative to arteriography for patients with severe stenosis or ulceration. This non-invasive method aids in clinical decision-making for carotid endarterectomy.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Neurology
Background:
- Carotid endarterectomy is a procedure to prevent stroke.
- Carotid arteriography is the traditional method for diagnosing carotid artery disease.
- Arteriography carries risks, especially for patients with comorbidities.
Purpose of the Study:
- To evaluate the accuracy and safety of duplex scanning for diagnosing carotid artery disease.
- To assess duplex scanning as an alternative to arteriography in specific patient populations.
Main Methods:
- Retrospective review of 25 patients (26 procedures) between July 1985 and September 1987.
- Carotid endarterectomy performed based on abnormal duplex scan findings (severe stenosis or ulceration).
- Duplex scan utilized B-mode ultrasonography and pulsed-Doppler spectral analysis.
Main Results:
- Duplex scan findings were confirmed by operative and pathological analyses in all cases.
- All 25 patients survived the surgery.
- Low complication rate: one transient and one permanent neurological deficit.
- Five perioperative deaths due to ventricular arrhythmias.
Conclusions:
- Duplex scanning is an accurate diagnostic tool for clinically significant carotid arterial occlusive disease.
- Duplex scanning provides a safe and effective alternative to arteriography for high-risk patients.