Angiography Before Carotid Endarterectomy--No

Having spentmy professional life depending on angiography prior to performing an operation, why would I now challenge this practice? There are several reasons. For years, surgeons and radiologists described findings relating to arteriographic studies such as the degree of stenosis, the presence or absence of ulceration, the length of the lesion, the status of the siphon, and the uncommon but disturbing presence of an intracerebral aneurysm. Which of these factors are important in determining who should undergo an operation? The only finding predicting outcome without an operation is the degree of stenosis.1-3If that is so, then the other findings from angiography are irrelevant unless they provide the surgeon with information guaranteeing a better and safer outcome from an operation. There is no evidence that any of the other factors noted by angiography will lead the surgeon to perform a safer operation with a better result.4 Duplex