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Giornale Italiano di Chirurgia Vascolare 1998 December;5(4):227-36

Copyright © 2000 EDIZIONI MINERVA MEDICA

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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