Can duplex ultrasonography select appropriate patients for carotid endarterectomy?

Objectives:This study investigated the reliability of carotid duplex ultrasound (DUS) to identify appropriate candidates for carotid endarterectomy (CEA) according to a panel of vascular specialists.Design:Prospective study.Material:102 patients with 145 carotid bifurcation stenosis or occlusions.Methods:All patients who required a carotid angiogram were evaluated using DUS followed by carotid angiography. A blinded panel of four vascular specialists individually decided whether CEA would be appropriate for each patient based on pre-angiographic information. Angiograms were then shown to panelists to see if their management decision was altered by the angiogram.Results:For stenosis ≥ 80% on DUS (n = 60), panelists unanimously agreed on CEA without angiography in 57 lesions. In 50 lesions (87.7%), angiography showed ≥ 70% stenosis and the management plan remained unchanged. For the other seven lesions, intracranial aneurysms (n = 2), tandem intracranial lesion (n = 1), unsuspected proximal common carotid lesion (n = 1), a 40% stenotic lesion (n = 1), and high carotid bifurcations (n = 2) were seen. In lesions with 50–79% stenosis on DUS (n = 66), none of the panelists recommended CEA without prior angiography. Eighteen (27%) of these lesions were ≥ 70% stenosed on angiogram. Complications of angiograms included one stroke, one haematoma, and one severe allergic reaction.Conclusion:Carotid duplex ultrasonography without angiography can reliably select lesions appropriate for surgery only when critical stenosis ≥ 80% is chosen. Routine angiography is recommended for carotid stenosis of 50–79% when CEA is considered