Carotid surgery without angiography is possible and safe

Background. To evaluate the possibility to perform carotid surgery without angiography. Methods. From January 1994 to June 1998, 514 patients with carotid obstruct ive disease were operated upon, 225 of them (43.8%) without previous angiog raphy; 55 out of 68 (80.8%) during the last six months. Eighty-one (36.0%) had lateralizing symptoms, 50 aspecific ones (22.2%) and 94 were asymptomat ic (41.8%), All patients were investigated by color-coded duplex sonography (CDS) of the arteries at the neck and by transcranial Doppler (TCD) and co mputed tomography (CT). One hundred eighty-eight patients were operated upo n under local anaesthesia and 37 under general anesthesia; 204 had a caroti d endartereotomy (90.7%) with patch angioplasty in 154 (75.5%), and 21 requ ired a bypass graft (9.3%). in 26 patients (11.5%) an indwelling shunt was needed. Results. Findings at surgery were consistent with CDS for plaque compositio n, ulcerations and degree of stenosis. There were no early deaths. Neurolog ic of ocular deficits occurred in 2 cases (0.9%), No strokes were observed in follow-up from 6 to 34 months. Conclusions, Carotid endarterectomy can be done without angiography in sele cted cases provided CDS plus TCD are of high quality. Under such conditions it can be considered a safer way to deal with carotid obstructive disease.