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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

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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


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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.

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