Chirurgia carotidea senza angiografia. Sei anni di esperienza.

Background. The aim of this study was to evaluate the efficacy and reliability of the preoperative non-invasive diagnostic protocol in carotid surgery in the light of current procedures. The study was based on a comparison between the data from this study and those from an earlier study carried out in 1997. Methods. A total of 421 cerebral revascularisation operations were performed between January 1997 and December 2000 in 387 patients aged between 42 and 86 years old (mean age 69 years). The indications for surgery can be expressed as follows in percentages: TIA in 54.87 % of cases; stroke in 13.06 % of cases, transitory amaurosis in 12.12 % of cases, hemodynamically significant stenosis (>70 %) in asymptomatic patients in 19.95 % of cases. Emergency operations were required in 39 cases (9.26%): in 15 cases owing to increasing TIA, in 5 cases for stroke in evolution, and in 19 cases for unstable neurological deficit. All patients underwent the following diagnostic protocol: C.W. duplex scan; b) colour Doppler ultrasonography; c) cranial CT. We evaluated: 1) the extent of stenosis by measuring peak systolic velocity (PSV) and final diastolic velocity (EDV); 2) the presence of fresh thrombus; 3) the presence of ulcerations and/or excavations, 4) the extension of atheroma; 5) the correspondence between the extent of stenosis and the ophthalmic arterial flow. Thirty-six patients (8.55 %) underwent angiography using DSA. Results. The results obtained do not reveal any substantial differences in terms of intra- and perioperative morbidity and mortality using the different diagnostic protocols. Conclusions. In conclusion we believe that the use of angiography should be restricted to selected cases presenting a doubtful interpretation using the non-invasive diagnostic protocol. This allows considerable reductions to be achieved in costs and hospitalisation times.