Selection of patients for carotid endarterectomy

Objective: The aim of this study was the definition of the duplex scan para meters that best select patients for carotid endarterectomy. Methods: This study was set in a regional vascular unit. Duplex scanning an d angiography were performed prospectively on 50 patients who were symptoma tic (100 carotid bifurcation) to identify the most accurate and sensitive d uplex scan criteria to identify an 80% to 99% stenosis according to the Eur opean Carotid Symptomatic Trial. With data from the European Carotid Sympto matic Trial, we estimated the effect of three different approaches used to select patients for carotid endarterectomy. The first approach was the sele ction of patients for carotid surgery on the basis of duplex scanning alone with the most accurate duplex scan criteria (approach I). The second appro ach was the selection of patients for carotid surgery on the basis of duple x scanning alone with a 100% sensitive duplex scan criteria (approach II). The third approach was the selection of patients for angiography with duple x scanning (100% sensitive criteria) and then the use of angiography to def ine which patients should undergo surgery (approach III). Results: All three approaches appeared to have a similar potential in strok e reduction. However, approach I, which minimized the number of patients wh o underwent surgery (19% less than approach II) or invasive imaging (65% le ss than approach III), appeared to be the most appropriate. Conclusion: These data support the selection of patients for carotid endart erectomy on the basis of duplex scanning alone. The duplex scan criteria sh ould be validated against angiography.