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Carotid surgery without arteriography: Noninvasive selection of patients

  • Published:
Annals of Vascular Surgery

Abstract

All carotid noninvasive studies at our institution comprised of duplex scanning, spectral frequency analysis, and ocular-pneumoplethysmography-Gee supraorbital Doppler assessments from 1985–1987 were reviewed. Forty symptomatic and 104 asymptomatic internal carotid arteries, concomitantly studied noninvasively and arteriographically, were identified. All studies were rereviewed prospectively and in blinded fashion. Utilizing peak frequency—internal carotid artery >10 mHz and carotid index (Pf-ICA)/PF-common carotid) >5 as criteria for surgery, 39/40 symptomatic internal carotid arteries were considered appropriate for carotid endarterectomy by noninvasive study. All of these internal carotid arteries had arteriographic confirmation of >50% internal carotid artery stenosis; 22 of them met noninvasive criteria for surgery of peak systolic frequency-internal carotid artery 14 mHz, carotid index >7 and abnormal ocular-pneumoplethysmography-Gee supraorbital Doppler. All of these had arteriographic confirmation of >80% internal carotid artery stenosis. Eleven asymptomatic internal carotid arteries met spectral frequency criteria for carotid endarterectomy but had normal ocular-pneumoplethysomgraphy-Gee/supraorbital Doppler. Eight in this group had <80% stenosis on arteriographic exam. Carotid endarterectomy may be performed without prior arteriography, provided objective criteria are established in a reliable noninvasive lab and met by individual patients.

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Authors and Affiliations

  1. Surgical Service, Division of Vascular Surgery, Massachusetts General Hospital, Boston, Massachusetts

    Jonathan P. Gertler MD, Richard P. Cambria MD, J. Philip Kistler MD, Stuart C. Geller MD, Nancy R. MacDoanld RN, David C. Brewster MD & William M. Abbott MD

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  1. Jonathan P. Gertler MD
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  2. Richard P. Cambria MD
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  3. J. Philip Kistler MD
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  4. Stuart C. Geller MD
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  5. Nancy R. MacDoanld RN
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  6. David C. Brewster MD
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  7. William M. Abbott MD
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Gertler, J.P., Cambria, R.P., Kistler, J.P. et al. Carotid surgery without arteriography: Noninvasive selection of patients. Annals of Vascular Surgery 5, 253–256 (1991). https://doi.org/10.1007/BF02329382

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  • DOI: https://doi.org/10.1007/BF02329382

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