Carotid endarterectomy with and without preoperative angiography

Background and Purpose: We aimed to investigate whether carotid endarterectomy based on preoperative standardized Doppler-/duplex sonography but without x-ray angiography is associated with an increased operative stroke rate.

Methods: During a 8 year period 392 consecutive patients (mean age 65.6 years, SD 9 years; 74% men) underwent carotid endarterectomy at a single center. All patients had standardized preoperative and postoperative neurological examination including colour-coded duplex sonography. 126 patients (32%) underwent x-ray angiography before endarterectomy, 266 (68%) were operated only on sonographic findings.

Results: 15 of 266 (5.6%) patients without angiography suffered a perioperative stroke compared to 5 of 126 (4.0%) patients with this procedure. Risk of stroke was not increased in patients without preoperative angiogram (odds ratio 1.446; 95% confidence interval 0.514 to 4.072, P=0.648). This even was more evident after adjustment for sex, age, preoperative (recurrent) stroke, degree of ipsilateral and contralateral stenosis, and experience of surgeon (adjusted odd ratio 0.943, 95% confidence interval 0.318 to 2.791, P=0.915).

Conclusions: Preoperative assessment of carotid stenosis solely based on standardized ultrasonography is not associated with an increased operative stroke risk compared to patients with additional angiography of carotid arteries.