Cirugía carotídea sin arteriografía. Tres años de experiencia en 116 pacientes

Abstract

Summary Introduction In a previous study conducted by our service we validated the use of Doppler ultrasound scanning of supra-aortic trunks in the diagnosis and therapeutic indication in cases of carotid lesions. Several indications were obtained in which Doppler ultrasound was enough to confirm a carotid endarterectomy. Carotid surgery (CS) without arteriography was later started on the basis of criteria previously obtained from the Doppler ultrasound scan. Aims Our aim was to determine the morbidity and mortality, both immediate and late, as well as the long term incidence of restenosis in the groups of CS with and without arteriography. Comparisons were made with the literature and between the two groups. Patients and methods We conducted a prospective, non-random study. Between 1/1/1998 and 31/12/2000, 215 patients were submitted to operations involving CS in our centre; of these, 116 (53.95%) underwent surgery without arteriography (group A) and in 99 (46.05%) cases arteriography was employed (group B). Comparisons were drawn up between the distribution of males and females, risk factors, clinical features and the surgical techniques used in both groups, and the results of the intervention. Results No statistically significant differences were found regarding risk factors, cranial CAT scan, clinical features or surgical technique. In group A: overall mortality was 0.86%, morbidity in symptomatic patients was 4.44% and 2.81% in those who were asymptomatic. In group B: mortality was 0%, morbidity in symptomatic patients was 5.12% and 1.66% in those who were asymptomatic. Long term restenosis rate (stenotic lesions above 50%; average of two years) was 4.3% in group A and 5.05% for group B, and no statistical differences were obtained. Conclusions Both the morbidity and mortality and the restenosis rates displayed in the group without arteriography lie within the limits admitted by the literature for both symptomatic and asymptomatic patients. We believe that CS can be performed without arteriography in cases that have been previously selected by our Vascular Diagnosis Laboratory, both in symptomatic and asymptomatic patients.