Preoperative angiography is outdated

BMJ 1995;310:1136 (29 April)

Letters

Preoperative angiography is outdated

EDITOR,--I am surprised that Mark Lambert should minimise theimpact of carotid endarterectomy¹ as its benefits have beenmore than proved in randomised controlled studies. Much of hiscriticism seems to hinge on his contention that angiographycauses stroke in 1% of patients and that if this figure is addedto the surgical morbidity and mortality the whole thing becomesworthless. He does not seem to accept or understand that mostcentres these days do not perform angiography before carotidendarterectomy. In my centre, for example, we have performedangiography in few cases in the past seven years and operateon many patients with carotid stenosis. Duplex scanning is allthat is required in most cases and has no mortality.

Lambert mentions that, of over 97000 strokes each year, only154 can be prevented by carotid endarterectomy. He fails tomention that the remaining cases (>96000) cannot be prevented,even . . . [Full text of this article]

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