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(Stroke. 2004;35:370.)
© 2004 American Heart Association, Inc.

Advances in Stroke 2003

Is Ultrasound Sufficient for Vascular Imaging Prior to Carotid Endarterectomy?

John W. Norris, MD, FRCP Alison Halliday, FRCS

From the Departments of Clinical Neurosciences and Vascular Surgery, St Georges Hospital Medical School, London, UK

Correspondence to John W. Norris, MD, Dept of Clinical Neurosciences, St Georges Hospital Medical School, Cranmer Terrace, London SW17 ORE, England. E-mail j.norris@sghms.ac.uk

Key Words: Advances in Stroke • carotid endarterectomy • catheter angiography • magnetic resonance angiography • ultrasonography

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Clinical trials of carotid endarterectomy (CEA) published over the last decade in both symptomatic and asymptomatic patients have emphasized the importance of accurate vascular imaging prior to operation. Different methods of evaluating carotid stenosis using digital subtraction angiography (DSA)¹ and between ultrasound and angiographic measurements² explain many of the discrepancies between clinical outcomes of the different surgical trials.

DSA is usually considered the "gold standard" but has a 1% to 2% stroke and death rate, which significantly impacts on surgical results in centers of excellence, where the combined mortality and morbidity of carotid endarterectomy is as low as 1.5%.³ However, no consensus has yet been arrived at for noninvasive imaging alternatives (ultrasound alone, magnetic resonance angiography [MRA] alone, or both combined) to replace DSA. In a recent "Controversies" section of this journal, strongly contrasting viewpoints on the value of ultrasound and MRA^3,4 were followed by comments by the section editors, who even disagreed with each other.⁵

Different surgical specialties also differ from each other in presurgical imaging assessment. In a recent survey in Canada⁶ of surgeons specializing in carotid endarterectomy, 50% still used DSA as their method of choice, but whereas 46% of vascular surgeons used ultrasound alone, this was used as the sole method of neurovascular imaging in only 11% of neurosurgeons (a significant difference, P=0.002). Published data comparing ultrasound to DSA (assuming this is the gold standard) all indicate a high degree of specificity and sensitivity, but not 100%, so leaving room for errors in surgical judgment. . . . [Full Text of this Article]