Published online before print June 26, 2003, doi: 10.1161/01.STR.0000079175.59874.62
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(Stroke. 2003;34:1816.)
© 2003 American Heart Association, Inc.
Controversies in Stroke |
For Severe Carotid Stenosis Found on Ultrasound, Further Arterial Evaluation Is Unnecessary
From the Division of Vascular Surgery, UCLA Center for the Health Sciences, Los Angeles, Calif.
Correspondence to Wesley S. Moore, MD, Division of Vascular Surgery, UCLA Center for the Health Sciences, Box 956904, Los Angeles, CA 90095-6904. E-mail wmoore@mednet.ucla.edu
Key Words: angiography • carotid endarterectomy • carotid stenosis
An extract of the first 250 words of the full text is provided, because this article has no abstract. |
The objective of performing carotid endarterectomy (CEA) is to reduce the risk of stroke. CEA can be justified only if the stroke morbidity and mortality from operation is significantly less than with alternative methods of management. Complications associated with preoperative invasive diagnostic procedures must be counted against the risk of operation because the invasive diagnosis would likely not be performed if surgery were not contemplated.
Intra-arterial contrast angiography carries several risks including the risk of stroke and death. These risks are increased in patients with severe cerebrovascular occlusive disease as opposed to the risk in patients with indications for angiography other than carotid bifurcation disease.
The benefits of carotid endarterectomy become more compelling to the extent that morbidity and mortality related to all aspects of perioperative management can be reduced. Clinical investigation, experience, and surgeon competence have combined to bring the risk of operation close to an irreducible minimum. The opportunity to further reduce perioperative risk by eliminating the need for contrast angiography is perhaps the single best method to achieve a major risk reduction for patients selected to undergo carotid endarterectomy.
Risks of Angiography
The risk of minor stroke as a consequence of diagnostic angiography is reported to range from 1.3% to 4.5%, and the risk of major stroke from 0.6% to 1.3%.1–3 In the Asymptomatic Carotid Atherosclerosis Study (ACAS) trial, in which randomization occurred prior to angiography, all patients who were randomized to the surgical arm were required to undergo postrandomization angiography. That design provided the opportunity to assess the true
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