ORIGINAL ARTICLES  VASCULAR PAPERS 

The Journal of Cardiovascular Surgery 2000 August;41(4):601-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Carotid surgery without angiography is possible and safe

Benedetti-Valentini F., Gossetti B., Irace L., Intrieri F., Marti-nelli O., Trenti E., Stumpo R., Costa P.

From the 2nd Chair of Vascular Surgery University “La Sapienza”, Rome, Italy

Background. To eval­u­ate the pos­sibil­ity to per­form carot­id sur­gery with­out angio­gra­phy.
Methods. From January 1994 to June 1998, 514 ­patients ­with carot­id obstruc­tive dis­ease ­were oper­at­ed ­upon, 225 of ­them (43.8%) with­out pre­vi­ous angio­gra­phy; 55 out of 68 (80.8%) dur­ing the ­last six ­months. Eighty-one (36.0%) had lat­er­al­iz­ing symp­toms, 50 aspe­cif­ic ­ones (22.2%) and 94 ­were asymp­to­mat­ic (41.8%). All ­patients ­were inves­ti­gat­ed by color-cod­ed duplex sonography (CDS) of the arter­ies at the ­neck and by transcranial Doppler (TCD) and computed tomography (CT). One hun­dred ­eighty-­eight ­patients ­were oper­at­ed ­upon ­under ­local anaesthe­sia and 37 ­under gen­er­al anes­the­sia; 204 had a carot­id endar­ter­e­ot­o­my (90.7%) ­with ­patch angio­plas­ty in 154 (75.5%), and 21 ­required a ­bypass ­graft (9.3%). In 26 ­patients (11.5%) an ind­well­ing ­shunt was need­ed.
Results. Findings at sur­gery ­were con­sis­tent ­with CDS for ­plaque com­po­si­tion, ulcer­a­tions and ­degree of sten­o­sis. There ­were no ear­ly ­deaths. Neurologic or ocu­lar def­i­cits ­occurred in 2 cas­es (0.9%). No ­strokes ­were ­observed in fol­low-up ­from 6 to 34 ­months.
Conclusions. Carotid endar­te­rec­to­my can be ­done with­out angio­gra­phy in select­ed cas­es pro­vid­ed CDS ­plus TCD are of ­high qual­ity. Under ­such con­di­tions it can be con­sid­ered a saf­er way to ­deal ­with carot­id obstruc­tive dis­ease.