Indications for carotid endarterectomy without arteriography:: A validation study using eco-Doppler

Introduction. The possibility of diagnosing carotid stenosis and carrying out surgery without arteriography has increased with the use of different diagnostic methods. The eco-Doppler has been shown to be a useful method, although it requires previous individualised validation. Objective. We aim to validate our Vascular Diagnostic Laboratory in the diagnosis of stenosis of the carotid bifurcation using eco-Doppler as compared with angiography, and the therapeutic indication thus obtained. Patients and methods. We made a prospective study for one year of 62 consecutive patients diagnosed on eco-Doppler as having carotid stenosis of over 70% and subsequent carotid arteriography. The treatment indicated is given, without waiting for the result of the angiography, on clinical evaluation, computerized tomography or cranial magnetic resonance and eco-Doppler; and subsequently on angiography. The degree of correlation of both methods, both for the therapeutic indication and for the degree of stenosis was determined Results. In five cases there was discrepancy and the therapeutic indication, was different. Three of these were related to the diagnosis of carotid occlusion and in the other two cases there were bilateral lesions of over 50% on eco-Doppler, which were classified as minor on angiographic study. In the group with stenosis of over 70% with <50% contralateral stenosis, eco-Doppler showed sensitivity and specificity of 100% with a kappa correlation index = I. Conclusion. It is possible to indicate carotid endarterectomy inpatients with unilateral stenosis greater than 70% and contralateral stenosis <50%, based on the eco-Doppler studies done in our Vascular Diagnostic Laboratory.