Extracranial and Transcranial Color-Coded Sonography Reduce the Need for Angiography Prior to Carotid Endarterectomy

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Abstract
The growing need for carotid endarterectomy must be accompanied by safe and reliable methods of imaging the cerebral circulation. The authors used extracranial and tran scranial color-coded sonography to evaluate the cervical carotid arteries and the basal cerebral circulation in 76 patients prior to surgery, aiming to reduce the need for preop erative angiography. In 3 patients (proximal and distal carotid disease; subtotal occlusion) carotid ultrasound failed to define the nature and extent of stenosis adequately, and thus conventional angiography was performed. Transcranial imaging identified intracranial stenotic disease in 4 patients and interhemispheric collateral flow in 29 patients. All patients underwent carotid endarterectomy without any complications due to inadequate preoperative imaging. An ultrasound-based approach eliminated the need for angiography in the majority of patients with significant implications for risk reduction and financial expenditure.