[Carotid surgery without systematic preliminary angiography. 402 patients treated by surgery between 1986 and 1992]

Ultrasonography of the carotid bifurcation is a high performance technique for the detection of carotids stenosis. Associated with Doppler and echography, ultrasonography offers a means of precisely evaluating atheromatous stenoses of the bifurcation. The degree of narrowing can be calculated from the pulsed Doppler recordings and colour echo-Doppler measurements, reducing the subjective interpretation factor (the operator-dependent nature of the exploration is no longer related to data collection). Most severe stenoses can be diagnosed with these techniques. The question now is whether carotid angiography is still necessary to establish the indication for surgical endarterectomy. We attempted to give an answer based on our prospective series of 402 endarterectomies of the carotid bifurcation performed between 1986 and 1992 without prior routine angiography. Arteriography was performed occasionally in the pre-operative work-up but was limited to cases in which the ultrasonography was judged insufficient. We observed a mortality of 0.25% and a morbidity of 0.5%. This diagnostic approach is justified by its lower cost and reduced risk due to arteriography. In addition, unidentified arterial lesions downstream have little or no effect on indications and outcome.