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A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2002 June;9(2):139-47

language: English, Italian

Chirurgia carotidea senza angiografia. Sei anni di esperienza

Mirenda F., La Spada M., Mandolfino T., D’Alfonso M., De Caridi G., Stilo F., Spinelli F.

From the Institute of Thoracic and Cardiovascular Surgery University of Messina - Messina Vascular Surgery Department “Gaetano Martino” Policlinic Messina University Hospital - Messina


Background. The aim of ­this ­study was to eval­u­ate the effi­ca­cy and reli­abil­ity of the pre­op­er­a­tive non-inva­sive diag­nos­tic pro­to­col in carot­id sur­gery in the ­light of cur­rent pro­ce­dures. The ­study was ­based on a com­par­i­son ­between the ­data ­from ­this ­study and ­those ­from an ear­li­er ­study car­ried out in 1997.
Methods. A ­total of 421 cere­bral revas­cu­lar­isa­tion oper­a­tions ­were per­formed ­between January 1997 and December 2000 in 387 ­patients ­aged ­between 42 and 86 ­years old (­mean age 69 ­years). The indi­ca­tions for sur­gery can be ­expressed as fol­lows in per­cent­ag­es: TIA in 54.87% of cas­es; ­stroke in 13.06% of cas­es, tran­si­to­ry amau­ro­sis in 12.12% of cas­es, hemo­dy­nam­i­cal­ly sig­nif­i­cant sten­o­sis (>70%) in asymp­to­mat­ic ­patients in 19.95% of cas­es. Emergency oper­a­tions ­were ­required in 39 cas­es (9.26%): in 15 cas­es ­owing to increas­ing TIA, in 5 cas­es for ­stroke in evo­lu­tion, and in 19 cas­es for ­unstable neu­ro­log­i­cal def­i­cit. All ­patients under­went the fol­low­ing diag­nos­tic pro­to­col: C.W. duplex ­scan; b) ­colour Doppler ultra­so­nog­ra­phy; c) cra­ni­al CT. We eval­u­at­ed: 1) the ­extent of sten­o­sis by meas­ur­ing ­peak sys­tol­ic veloc­ity (PSV) and ­final dia­stol­ic veloc­ity (EDV); 2) the pres­ence of ­fresh throm­bus; 3) the pres­ence of ulcer­a­tions and/or exca­va­tions, 4) the exten­sion of ather­o­ma; 5) the cor­re­spon­dence ­between the ­extent of sten­o­sis and the oph­thal­mic arte­ri­al ­flow. Thirty-six ­patients (8.55%) under­went angio­gra­phy ­using DSA.
Results. The ­results ­obtained do not ­reveal any sub­stan­tial dif­fer­enc­es in ­terms of ­intra- and per­i­op­er­a­tive mor­bid­ity and mor­tal­ity ­using the dif­fer­ent diag­nos­tic pro­to­cols.
Conclusions. In con­clu­sion we ­believe ­that the use of angio­gra­phy ­should be restrict­ed to select­ed cas­es pre­sent­ing a doubt­ful inter­pre­ta­tion ­using the non-inva­sive diag­nos­tic pro­to­col. This ­allows con­sid­er­able reduc­tions to be ­achieved in ­costs and hos­pi­tal­isa­tion ­times.

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