Carotid Endarterectomy without Pre-operative Angiography

Carotid endarterectomy is being performed with increasing frequency without the benefit of preoperative angiography, based purely on duplex scanning. The available data attest to its safety, with the caveats that the duplex scan is unimpeachable, and that the symptoms and duplex scan findings are consistent. Given the well documented risk of stoke as a consequence of cerebral angiography being at least 1%, the elimination of this risk by the omission of contrast angiography would reduce the neurological morbidity and mortality rate of the diagnosis and treatment of carotid bifurcation disease by approximately 50%. The available data make a compelling case for carotid endarterectomy based on duplex scanning, without preoperative angiography, as the preferred approach to treatment of carotid artery stenosis.