107 Conventional Catheter-based Angiography Versus Non-invasive Imaging in the Evaluation of Symptomatic Carotid Disease

INTRODUCTION: The indication for invasive treatment of symptomatic carotid disease with CEA or carotid stenting was established based on catheter digitally subtracted imaging (DSA) however operative referral for symptomatic carotid disease is still largely based on non-invasive imaging such as CTA or ultrasound. METHODS: Retrospective analysis all consecutive patients who were referred for evaluation and treatment of symptomatic carotid disease after non-invasive imaging with CTA or ultrasound showed ipsilateral carotid stenosis of >50% or occlusion. Patients were included if they had ipsilateral cerebral or ocular ischemia within two weeks of index event. RESULTS: A total of 280 patients with stenosis >50 and <100% were included. Of those, 53 (19%) were found to have stenosis <50% leading to treatment with best medical therapy instead of intervention. Out of 50 patients with total occlusion, 16 (32%) were found to have a string sign and were treated with stenting. Percent stenosis of 80 or more on non-invasive imaging was more likely to correlate with stenosis of 50% or more on DSA. CONCLUSIONS: In a cohort of two large North American institutions, 19% of patients referred for revascularization of symptomatic carotid disease based on non-invasive imaging were found to have non-significant carotid stenosis and were treated with best medical therapy and 32% of those with suspected occlusion were successfully revascularized. Our findings highlight the importance of catheter cased angiography in the evaluation of carotid disease.