Perioperative stroke during carotid endarterectomy: the value of intraoperative angiography.

Stroke following carotid endarterectomy is ordinarily attributed to carotid occlusion without adequate shunting, to embolization of air, atheroma, or thrombus, or to the elevation of an intimal flap. In 146 carotid endarterectomies in which intraoperative arteriography was not used, we observed a mortality of 4.8% and an incidence of perioperative stroke of 6.8%. In a subsequent group of patients in which 137 endarterectomies were performed with 107 intraoperative arteriograms to assess the immediate post-surgical results, there was a mortality of 1.5% and an incidence of perioperative stroke of 3.6%. We attribute this difference, in part, to the revision of 12 internal carotid artery defects observed on the arteriograms. Intraoperative arteriography was easy to perform and without complication; however, we recommend that consideration be given to ultrasound as a potentially useful way in the future of assessing technical results.