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International Angiology 2000 March;19(1):1-7


lingua: Inglese

Preoperative imaging of the carotid bifurcation. Current trends

Athanasoulis C. A., Plomaritoglou A.

From the Departments of Radiology and * Neurology Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.


Background. There is dis­agree­ment about the most appro­pri­ate imag­ing exam­ina­tion nec­es­sary for the pre­op­er­a­tive assess­ment of the carot­id bifur­ca­tion. Our objec­tive was to find out the pref­er­enc­es of cli­ni­cians on this issue in one large hos­pi­tal. And to deter­mine wheth­er and how these pref­er­enc­es have ­changed over time.
Methods. Study ­design: Observational, ret­ro­spec­tive study. Setting: Large met­ro­pol­i­tan and uni­ver­sity affil­i­at­ed hos­pi­tal. Numbers of ­patients per year who under­went carot­id endar­te­rec­to­my dur­ing 1990-1998. Numbers of ­patients per year who had con­ven­tion­al cath­e­ter carot­id angio­gra­phy dur­ing the same peri­od. Assessment of the ­nature of pre­op­er­a­tive carot­id imag­ing in a sam­ple of 400 ­patients (100 each in 1990, 1993, 1996 and 1998). Analysis of the types of imag­ing exam­ina­tions by year and deter­mi­na­tion of under­ly­ing ­trends. Measures: Number of carot­id angio­grams ­expressed as a per­cent­age of carot­id endar­te­rec­to­mies per­formed each year. Types of pre­op­er­a­tive imag­ing exam­ina­tions of the carot­ids and chang­es over time.
Results. The num­ber of pre­op­er­a­tive con­ven­tion­al cath­e­ter angio­grams ­decreased over time. In 1990 angio­gra­phy was per­formed in 86% of carot­id endar­te­rec­to­mies. In 1998 the pro­por­tion ­decreased to 16% (p<0.05). Conversely, the pro­por­tion of endar­te­rec­to­mies car­ried out based sole­ly on ultra­so­nog­ra­phy ­increased from 6% in 1990 to 56% in 1998 (p<0.05). The pro­por­tion of endar­te­rec­to­mies per­formed based on the com­bined find­ings of ultra­sound and mag­net­ic res­o­nance angio­gra­phy ­increased from 3% in 1990 to 56% in 1996 and to 26% in 1998. Computed tomoan­gio­gra­phy has not ­become pop­u­lar. The ­observed reduc­tion in the num­ber of pre­op­er­a­tive con­ven­tion­al carot­id angio­grams was inde­pen­dent of the pres­ence/­absence of symp­toms, the level of serum crea­ti­nine, the sub­spec­ial­ty of the sur­geon (vas­cu­lar sur­gery vs neu­ro­sur­gery) and the indi­vid­u­al sur­geon ­involved.
Conclusions. In one large uni­ver­sity affil­i­at­ed hos­pi­tal the trend in the pre­op­er­a­tive imag­ing of the carot­id arter­ies is moving away from con­ven­tion­al cath­e­ter angio­gra­phy. There is increas­ing appli­ca­tion of ultra­sound com­bined with mag­net­ic res­o­nance angio­gra­phy and a more pro­nounced trend ­towards the per­for­mance of carot­id endar­te­rec­to­my based only on ultra­so­nog­ra­phy.

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