THE USE OF DIRECT INTRAOPERATIVE DOPPLER ULTRASONOGRAPHY IN CAROTID THROMBOENDARTERIECTOMY - A PROSPECTIVE-STUDY

Large multicenter studies have recently provided long-term results sub stantiating the superiority of surgical as compared to conservative tr eatment for symptomatic and asymptomatic extracranial internal carotid stenoses of more than 70%. These results led to an increase in the fr equency of thrombo-endarteriectomies. However, indications are limited by the peri-operative complication rate. This explains the need for i ntra-operative quality control. The present study compares the standar d method of intraoperative quality control in carotid surgery, i.e., i ntra-operative angiography (IOA), with direct intra-operative Doppler ultrasonography (IDU). Thirty-four patients who underwent carotid thro mbo-endarteriectomy (carotid TEA) for a symptomatic (n = 15) or asympt omatic (n = 19) carotid stenosis of more than 70% were submitted to bo th intra-operative IOA and IDU. The sensitivity and specificity of the two techniques were compared in the light of the intra-operative find ings. IDU seems to be superior to IOA in the detection of vasospasm. I OA has a higher sensitivity in demonstrating minisaccules, which; howe ver, are not therapeutically relevant. The other findings obtained wit h both methods were considered to be of equal value. There were no fal se negative results by IDU regarding therapeutically relevant findings . We therefore consider it advisable to apply IDU in every case of car otid TEA. IOA should be performed in patients with vessel changes dete cted by IDU.