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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 1998 December;5(4):227-36
language: English, Italian
Carotid endarterectomy without angiography. A prospective randomized study. Interim results
Milite D., Mellone G., Bonvicini C., Mercurio D., De Francesco T., Damiani N., Grego F., Deriu G. P.
From the Clinic of Vascular Surgery Padua University, Padua, Italy
Background. Angiography is generally regarded as the “gold standard” for the evaluation of the cerebrovascular circulation prior to carotid endarterectomy. However, the risks and cost of angiography have prompted many authors to use colour flow duplex scanning alone for surgical evaluation.
Aims. The aims of this prospective study were: 1) to assess the reliability of colour flow duplex scanning versus angiography and ex vivo measurement as a means of evaluating the degree of carotid stenosis; 2) to analyse whether carotid endarterectomy performed without preoperative angiography presents a greater risk of complications.
Methods. During the first phase of the study from April to December 1997, 65 patients undergoing carotid endarterectomy were compared in order to evaluate the difference between the ex vivo measurement of stenosis and that obtained using angiographic and ultrasound methods. In the second phase, which is still underway, the patients undergoing carotid endarterectomy were randomly divided into 2 groups: Group A underwent both colour flow duplex scanning and angiography, whereas Group B only underwent colour flow duplex scanning.
Results. Colour flow duplex scanning showed a sensitivity of 95%, specificity of 98% and accuracy of 93% in the diagnosis of carotid stenosis between 70 and 99%. These results were slightly higher than angiography (92, 98 and 90% respectively).
Conclusions. The small number of patients included in the randomised study to date (38 in Group A and 30 in Group B) is not statistically relevant; the initial impression is that carotid endarterectomy using colour flow duplex scanning alone does not present additional risks.