THE VALUE OF ROUTINE COMPUTED-TOMOGRAPHY OF THE BRAIN IN THE PREOPERATIVE ASSESSMENT OF PATIENTS FOR CAROTID ENDARTERECTOMY

Objective. To determine the prevalence of brain infarcts and other int racranial pathology on computed tomography (CT) in patients with great er than 50% internal carotid artery stenosis. Design. Descriptive stud y of CT findings. Setting. Referral-based cohort at Groote Schuur Hosp ital. Participants. Sixty-three patients aged 40 - 82 years who had CT of the head prior to carotid endarterectomy. Main outcome measures. P revalence of brain infarct in patients presenting with transient ischa emic attack (TIA) or stroke, and yield of unsuspected intracranial pat hology other than ischaemic necrosis. Results. Brain infarcts were dia gnosed in 54% of patients presenting with TIA and in 73% of patients w ith stroke. True-positive CT scans were present in only 19% and 44% of patients with TIA and stroke, respectively, A single incidental front al lobe granuloma, unrelated to the patient's clinical presentation, w as noted. Conclusions, In the selected group of patients referred for carotid endarterectomy, routine use of CT of the head is not indicated and can be reserved for cases with extraordinary clinical features.