Abstract Number ‐ 168: Conventional angiography versus non‐invasive imaging in the assessment of symptomatic carotid disease

Abstract

Introduction The indication for carotid endarterectomy in symptomatic carotid stenosis of 50% or more was established based on catheter angiography. Yet, in practice, operative referral is still largely based on non‐invasive imaging. We sought to determine the discrepancy between the two modalities in our retrospective cohort. Methods We retrospectively collected data from consecutive symptomatic patients between 2019 and 2021 at our institution who were referred for evaluation and possible stenting of carotid disease based on non‐invasive imaging showing moderate to severe stenosis or occlusion. All patients underwent digitally subtracted angiography (DSA) and were treated with stenting if there was stenosis of 50% or above or if there was presence of a string sign. Otherwise, they were continued on best medical therapy. Results 98 total patients were referred for evaluation of carotid disease (Median age 60, 37% women). 21/98 were found to have a carotid occlusion on non‐invasive imaging, of those, 6 (28%) were found to have a string sign on CTA and were treated with stenting. 77/98 were found to have moderate to severe carotid artery stenosis based on non‐invasive imaging. Of those, 31 patients (40%), were not found to have significant carotid artery stenosis and were not treated with stenting. Out of total 99 patients who were referred for carotid intervention based on non‐invasive imaging, 38 (40%) patients had a change in the treatment plan. Conclusions 40% of the patients who were referred for revascularization based on non‐invasive imaging had a change in the treatment after conventional catheter angiography. Larger studies are warranted to confirm our findings.