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

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.