A CRITICAL ANALYSIS OF CEREBRAL COMPUTED-TOMOGRAPHY SCANNING BEFORE ELECTIVE CAROTID ENDARTERECTOMY AND ITS CORRELATION TO CAROTID STENOSIS

Background. Cerebral computed tomography (CT) scanning has been sugges ted to play a role in the management of patients before carotid endart erectomy (CEA). This prospective study analyzes the value of CT scanni ng before elective CEA and the correlation of CT findings to significa nt carotid stenosis. Methods. This study includes 131 consecutive pati ents considered for CEA during a 2-year period. Alb patients underwent carotid duplex ultrasonography, carotid arteriography, and CT scannin g. Results. Eighty patients (61%) had transient ischemic attacks or pr ior strokes, and 51 (39%) had nonhemispheric symptoms or were asymptom atic. The CT scan was abnormal in 36 (27%) patients; however, no brain tumors or abnormalities to affect clinical management were revealed. Ninety-two CEAs were performed on 87 patients. Twenty-nine (32%) in th e operative group had abnormal CT scans, but these did not influence o perative decisions. On the basis of this rate of 0% of patients with C T findings to change surgical management in 92 cases, a maximum true r ate of occurrence of up, to 5% could be detected with or equals 0.05 b y sampling a population of this size. Four patients (4%) had postopera tive cerebral vascular accidents, and all of these had normal preopera tive scans. Patients with 50% or more carotid stenosis on arteriogram were significantly more likely to have abnormal CT scans than patients with less than 50% stenosis (20% versus 7%, p = 0.0034), iis carotid stenosis became more significant, the frequency of abnormal CT scans i ncreased (p < 0.01). The cost of CT scanning was $66,089.50 in this st udy. Conclusions. Significant carotid stenosis was associated with a h igher frequency of abnormal CT scans; however, routine preoperative CT scanning was unnecessary before elective CEA.