A critical analysis of cerebral computed tomography scanning before elective carotid endarterectomy and its correlation to carotid stenosis

被引:4
作者
AbuRahma, AF
Robinson, PA
Killmer, SM
Kioschos, JM
Roberts, MD
机构
[1] W VIRGINIA UNIV, CHARLESTON AREA MED CTR, ROBERT C BYRD HLTH SCI CTR, DEPT SURG, CHARLESTON, WV USA
[2] BOEHRINGER INGELHEIM PHARMACEUT INC, RIDGEFIELD, CT 06877 USA
[3] OREGON HLTH SCI UNIV, DEPT ORTHOPED, PORTLAND, OR 97201 USA
关键词
D O I
10.1016/S0039-6060(96)80109-7
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background. Cerebral computed tomography (CT) scanning has been suggested to play a role in the management of patients before carotid endarterectomy (CEA). This prospective study analyzes the value of CT scanning before elective CEA and the correlation of CT findings to significant carotid stenosis. Methods. This study includes 131 consecutive patients considered for CEA during a 2-year period. Alb patients underwent carotid duplex ultrasonography, carotid arteriography, and CT scanning. Results. Eighty patients (61%) had transient ischemic attacks or prior strokes, and 51 (39%) had nonhemispheric symptoms or were asymptomatic. The CT scan was abnormal in 36 (27%) patients; however, no brain tumors or abnormalities to affect clinical management were revealed. Ninety-two CEAs were performed on 87 patients. Twenty-nine (32%) in the operative group had abnormal CT scans, but these did not influence operative decisions. On the basis of this rate of 0% of patients with CT findings to change surgical management in 92 cases, a maximum true rate of occurrence of up, to 5% could be detected with or equals 0.05 by sampling a population of this size. Four patients (4%) had postoperative cerebral vascular accidents, and all of these had normal preoperative scans. Patients with 50% or more carotid stenosis on arteriogram were significantly more likely to have abnormal CT scans than patients with less than 50% stenosis (20% versus 7%, p = 0.0034), iis carotid stenosis became more significant, the frequency of abnormal CT scans increased (p < 0.01). The cost of CT scanning was $66,089.50 in this study. Conclusions. Significant carotid stenosis was associated with a higher frequency of abnormal CT scans; however, routine preoperative CT scanning was unnecessary before elective CEA.
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页码:248 / 251
页数:4
相关论文
共 14 条
[1]  
Chervu A, 1994, Ann Vasc Surg, V8, P296, DOI 10.1007/BF02018179
[2]   TIMING OF CAROTID-ARTERY ENDARTERECTOMY AFTER STROKE [J].
GIORDANO, JM ;
TROUT, HH ;
KOZLOFF, L ;
DEPALMA, RG .
JOURNAL OF VASCULAR SURGERY, 1985, 2 (02) :250-254
[3]   STROKE AFTER CAROTID ENDARTERECTOMY - RISK AS PREDICTED BY PREOPERATIVE COMPUTERIZED-TOMOGRAPHY [J].
GRABER, JN ;
VOLLMAN, RW ;
JOHNSON, WC ;
LEVINE, H ;
BUTLER, R ;
SCOTT, RM ;
NABSETH, DC .
AMERICAN JOURNAL OF SURGERY, 1984, 147 (04) :492-497
[4]  
Horn M, 1994, Ann Vasc Surg, V8, P221, DOI 10.1007/BF02018167
[5]   SHORT-TERM AND MIDTERM RESULTS OF AN ALL-AUTOGENOUS TISSUE POLICY FOR INFRAINGUINAL RECONSTRUCTION [J].
KENT, KC ;
WHITTEMORE, AD ;
MANNICK, JA .
JOURNAL OF VASCULAR SURGERY, 1989, 9 (01) :107-114
[6]  
MARTIN JD, 1991, J VASC SURG, V14, P267
[7]   THE FALLACY OF THE LACUNE HYPOTHESIS [J].
MILLIKAN, C ;
FUTRELL, N .
STROKE, 1990, 21 (09) :1251-1257
[8]   SILENT STROKE AND CAROTID STENOSIS [J].
NORRIS, JW ;
ZHU, CZ .
STROKE, 1992, 23 (04) :483-485
[9]   USE OF COMPUTERIZED CEREBRAL-TOMOGRAPHY IN SELECTION OF PATIENTS FOR ELECTIVE AND URGENT CAROTID ENDARTERECTOMY [J].
RICOTTA, JJ ;
OURIEL, K ;
GREEN, RM ;
DEWEESE, JA .
ANNALS OF SURGERY, 1985, 202 (06) :783-787
[10]   PROSPECTIVE ANALYSIS OF CAROTID ENDARTERECTOMY AND SILENT CEREBRAL INFARCTION IN 97 PATIENTS [J].
SISE, MJ ;
SEDWITZ, MM ;
ROWLEY, WR ;
SHACKFORD, SR .
STROKE, 1989, 20 (03) :329-332