VALUE OF ANGIOSCOPY FOR INTRAOPERATIVE ASSESSMENT OF CAROTID ENDARTERECTOMY

From March 1992 to November 1993 we used angioscopy and arteriography for intraoperative assessment of 103 carotid endarterectomies in 96 pa tients. The indication for surgery was asymptomatic stenosis in 55 cas es and neurologic and/or ocular symptoms in 48. Intraoperative angiosc opy and arteriography were performed to allow comparison of findings. Intraoperative angioscopic images were normal in 67 cases and abnormal in 36. The defect was an intimal flap in 26 cases, detachment of the distal plaque in seven cases, and an intimal wedge in five cases. In t wo cases both detachment and a wedge were observed. The defect was not considered severe enough to warrant revision in 31 cases and was corr ected in five cases by either vein bypass (n = 1) or revision of the e ndarterectomy (n = 4). In the latter four cases repeat angioscopy show ed normal findings. Arteriographic and angioscopic findings were compa red in 102 cases. In the 71 cases in which angioscopic, findings were normal, arteriography revealed a major abnormality in three cases: kin king in one and stenosis >40% in two. Kinking was treated by attachmen t of the common carotid artery and stenosis by venous bypass. In the 3 1 cases in which angioscopy revealed defects not considered to warrant revision, arteriography revealed stenosis >40% in three cases treated by either prosthetic bypass (n = 2) or revision of the endarterectomy (n = 1). The false negative rate for angioscopy was 5.9% and concorda nce between the two methods was 94.1%. The combined mortality-morbidit y rate was 1.9% (one stroke and one death). Postoperative evaluation o f anatomic findings by arteriography or Doppler ultrasonography reveal ed asymptomatic internal carotid occlusion in one and internal carotid stenosis <30% in four cases. Angioscopy is a simple, low-cost method of intraoperative control that can be used either as an adjunct to art eriography or as an alternative if arteriography cannot be performed.