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Is carotid duplex scanning sufficient as the sole investigation prior to carotid endarterectomy?
P Collins, MB ChB1, I McKay, MB ChB1, S Rajagoplan, MRCS1, P Bachoo, MS, FRCS1, O Robb, FRCR1 and J Brittenden,
MD, FRCS2
Department of Radiology and 2 Department of Vascular Surgery, University of Aberdeen, Grampian NHS Trust, Ward 36,
Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
Carotid endarterectomy (CEA) is the accepted treatment for certain patients who have had, or who are at risk
of having, a stroke if they have a significant narrowing of the internal carotid artery. Rapid and accurate
classification of the degree of stenosis is important as the benefit of surgery is highly dependent on this.
The aim of this study was to assess whether the addition of angiography to duplex scanning resulted in a change
in patient management in a unit where duplex scanning was used as the sole imaging investigation prior to CEA.
The study population consisted of 64 patients with significant internal carotid artery stenosis on duplex scanning
who were suitable for, and wished to be considered for, CEA. All patients underwent an angiogram. In this study 9
(14%) patients did not proceed to surgery on the basis of angiography and in a further 11 (17%) patients insufficient
views of the distal vessel were obtained on duplex scanning. Three of these patients had extensive disease which
excluded surgery. One patient experienced a transient ischaemic attack (TIA) at the time of angiography. In conclusion,
this audit has highlighted the limitations in performing duplex scanning alone, and the costs that this can incur on
the patient who may undergo an unnecessary operation. We cannot recommend duplex scanning as the sole investigation
prior to CEA. There is need to evaluate the role of additional non-invasive carotid imaging such as magnetic resonance
angiography or CT angiography in the assessment of these patients.
NEJM: Volume 353:2001-2011November 10, 2005 Number 19
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