Arterial assessment before carotid endarterectomy: current practice in Great Britain and Ireland

Abstract

A survey of the management of patients with putative carotid artery disease by 245 vascular and neurosurgeons in Great Britain and Ireland was conducted with a 96 per cent response. Ninety-six (41%) surgeons performed at least one carotid endarterectomy in 1984 and a total of 1374 such operations were carried out in that year. Of the 40 surgeons who performed more than ten operations in 1984, 95 per cent generally employed a screening technique which was less invasive than conventional angiography in their management. Techniques based on ultrasonography were more popular than those based on digital subtraction angiography (DSA) in this respect. If carotid endarterectomy were to be undertaken, 63 per cent of surgeons required pre-operative conventional angiograms. Of the 38 per cent who did not routinely use conventional angiography, all but one used digital subtraction angiography. Ultrasonography and DSA have had a significant impact on the management of carotid artery disease in Great Britain and Ireland and their individual places in such management are becoming clear.