Carotid endarterectomy without angiography does not compromise operative outcome

Objectives: carotid angiography is associated with a 2% risk of stroke and, since the advent of colour-duplex ultrasound, ifs role in the assessment o f patients with carotid disease has been the subject of debate. The aim of this study was to evaluate a policy of adopting routine duplex supplemented by selective angiography on operative outcome over a 5-year period. Methods: a prospective audit of the results of carotid endarterectomy witho ut routine angiography from January 1992 to December 1996. Angiography was performed only if the ultrasonography was concerned about the distal or pro ximal extent of disease or to assess subocclusion. Results: during the study period, 494 carotid endarterectomies were perform ed but only 35 patients underwent carotid angiography. The indications for angiography were subocclusion/string sign in 22 patients, to assess the lim its of proximal or distal disease in 22 and abnormal anatomy in one. During the 5-year study period the overall perioperative death and/or stroke rate was 4.2%. By 1997, the perioperative stroke rate had fallen to 1.3%. In no case in this series was the operation abandoned due to unexpected findings . Conclusion: although concerns exist about the precise duplex criteria for d iagnosing a severe stenosis, this study has shown that a policy of selectiv e angiography does not compromise patient safety or operability and avoids the unnecessary mortality, morbidity and costs associated with routine angi ography.