Carotid endarterectomy based on duplex ultrasound in patients with and without hemispheric symptoms

Carotid endarterectomy is the most commonly performed vascular procedure. T his retrospective study was conducted to determine the efficacy of duplex i maging as the sole diagnostic study for preoperative evaluation of symptoma tic and asymptomatic patients who underwent carotid endarterectomy. We cond ucted a retrospective case series analysis in a community teaching hospital . From January 1994 to September 1998, 316 patients underwent carotid endar terectomy for carotid stenosis. A total of 177 patients were symptomatic an d 139 patients were asymptomatic. Angiography was performed routinely in th e beginning of the study but later was performed only in selected patients. Preoperative duplex ultrasound of carotid artery was performed by a labora tory accredited by the Intersocietal Commission for the Accreditation of Va scular Laboratories. Data were reviewed to obtain morbidity and mortality r ates, and duplex imaging results were compared with operative findings. Cos t and risk analysis of carotid angiography reviewed. This study reviewed va riables of age, sex, race, diabetes, smoking, hypertension, hypercholestero lemia, coronary artery disease, and renal failure. Five patients had a lesi on in the proximal portion of the carotid artery by duplex imaging criteria . Duplex ultrasound results were grossly confirmed intraoperatively in all patients except in one patient who was found to have complete occlusion of carotid artery whose duplex was read as high-grade stenosis. The duration o f stay ranged from two to 30 days. This duration was influenced by patients ' comorbid conditions, postoperative complications or simultaneous coronary artery bypass graft. Four patients had a stroke within 30 days of surgery making the stroke rate of 1.26 per cent. There has been considerable debate on the use of duplex ultrasound as the only method of preoperative evaluat ion of carotid stenosis before carotid endarterectomy. Our study demonstrat es that it is safe to perform carotid endarterectomy based on neurologic hi story and duplex ultrasound with good technical quality performed in an acc redited vascular laboratory. This approach eliminates the cost and risk ass ociated with angiography. Proximal carotid and intrathoracic lesions are ra re and can be predicted by the duplex study. We think that carotid angiogra phy is required only when duplex imaging is suboptimal or equivocal in the presence of atypical symptoms or uncommon vascular abnormalities.