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Carotid endarterectomy without angiography
Insights
Pulsed Doppler ultrasonic arteriography accurately quantifies carotid stenosis, offering a noninvasive alternative to traditional angiography for patients with contrast allergies or contraindications. This imaging technique aids in evaluating extracranial carotid occlusive disease.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Neurology
Background:
- Extracranial carotid occlusive disease requires accurate assessment of stenosis.
- Radiographic contrast media used in angiography can cause allergic reactions.
- Noninvasive imaging modalities are needed for patient groups unable to undergo standard angiography.
Observation:
- Three patients with unilateral and one with bilateral hemispheric symptoms underwent pulsed Doppler ultrasonic arteriography.
- These patients had contraindications to standard radiographic contrast media.
- The study focused on evaluating internal carotid artery stenoses.
Findings:
- Pulsed Doppler ultrasonic imaging with real-time spectrum analysis identified four high-grade (>50% diameter reduction) and one low-grade (<50% diameter reduction) internal carotid stenoses.
- Noninvasive findings were confirmed intraoperatively at endarterectomy in all five affected arteries.
- The technique accurately quantitated the degree of atherosclerotic stenosis at the carotid bifurcation.
Implications:
- Pulsed Doppler ultrasonic arteriography is a reliable, noninvasive method for assessing carotid bifurcation stenosis.
- This technique can serve as a substitute for conventional angiography in select patient populations.
- It improves diagnostic capabilities for patients with contrast media allergies or other contraindications to angiography.
Abstract:
Three patients with unilateral hemispheric symptoms suggestive of extracranial carotid occlusive disease and one patient with bilateral symptoms who were allergic to radiographic contrast media were studied by pulsed Doppler ultrasonic arteriography and real time spectrum analysis. Four high grade (greater than 50% diameter reduction) internal carotid stenoses and one low grade (less than 50% diameter reduction) stenosis were identified. The noninvasive findings were confirmed at endarterectomy in all five arteries. Pulsed Doppler ultrasonic imaging combined with real time spectrum analysis can accurately quantitate the degree of atherosclerotic stenosis at the carotid bifurcation. Experience with these four patients suggests that these techniques can be used in lieu of angiography to evaluate patients who are unable to undergo standard radiographic examination.