ROLE OF ARTERIOGRAPHY IN THE SELECTION OF PATIENTS FOR CAROTID ENDARTERECTOMY

Background Duplex ultrasonography is used increasingly to select patie nts for carotid endarterectomy. This study aims to clarify whether art eriography is still required. Methods A total of 272 patients in whom duplex imaging indicated significant disease of the internal carotid a rtery underwent arteriography and the results were compared. Regarding the arteriogram as the 'gold standard', three aspects were considered : the accuracy of duplex ultrasonography in detecting significant sten osis, the ability of duplex imaging to identify patients who should ha ve arteriography and whether the arteriogram provided important additi onal information that might influence a decision to operate. Results T hree patients (1 per cent) suffered a permanent neurological deficit a s a result of arteriography. Of the 272 patients with significant sten osis identified by duplex ultrasonography, 241 (89 per cent) were conf irmed as significant on arteriography. Duplex imaging was not able to predict accurately which arteriograms would provide useful additional information (sensitivity 59 per cent, specificity 65 per cent), wherea s 89 arteriograms (33 per cant) contained information that might have influenced subsequent management. Conclusion Duplex imaging is unable to detail the anatomy or determine the extent of carotid disease and m ay therefore lead to an inappropriate decision to perform carotid enda rterectomy. Duplex imaging alone is not adequate before carotid endart erectomy.