A COMPARISON OF QUALITY-CONTROL METHODS APPLIED TO CAROTID ENDARTERECTOMY

Objectives: To compare the ability of continuous wave Doppler (CWD), B -more ultrasound (BMU), angioscopy and transcranial Doppler (TCD) to d etect technical error during carotid endarterectomy (CEA). Design: A p rospective, comparative study in 100 consecutive patients. Setting: Le icester Royal Infirmary, Leicester, U.K. Materials: Intraoperative TCD monitoring was performed using a SciMed PcDop 842 2 MHz TCD. An Olymp us 2.8mm flexible angioscope was used to inspect the arterial lumen pr ior to restoration of bloodflow. After restoration of flow 10Mhz BMU i mages and 8Mhz CWD velocity spectra of carotid artery blood flow were obtained. Chief outcome measures: The detection of intimal flaps, thro mbus, stenoses or other errors of surgical technique likely to result in perioperative morbidity. Main results: CWD and BMU images were tech nically inadequate in 9% and 24% of cases respectively and neither tec hnique altered clinical management. Angioscopy demonstrated significan t technical errors in 12 cases (four intimal flaps, thrombus in eight) . TCD defected shunt malfunction? in 13% of patients, emboli during di ssection in 23% and early postoperative carotid artery thrombosis in t hree patients. Conclusions: A combination of TCD monitoring and comple tion angioscopy provided the maximum yield in terms of diagnosing tech nical error and establishing the cause of perioperative morbidity.