Cerebral angiography practices at US teaching hospitals. Implications for carotid endarterectomy.

Abstract

Although several clinical trials of carotid endarterectomy (CE) have been carried out in the last decade, the methods for angiographic measurement of carotid stenosis have not been standardized. How one measures carotid stenosis may affect the applicability of clinical trial results. We sought to obtain information on cerebral angiography practices at teaching hospitals in the United States. We surveyed hospitals with an accredited radiology residency program. Of the 200 radiology program directors who were sent the survey, 97 responded. The angiographic complication rate was known in 68 of 97 medical centers and averaged 0.6%. The most common method being used for measurement of carotid stenosis is the NASCET method (70%). Forty-two of 97 program directors reported a decrease in the volume of angiography being performed. Of these 42, one third reported that CE was commonly being performed on the basis of noninvasive tests alone. The angiographic complication rate at American teaching hospitals is within the "acceptable" range. The NASCET method of stenosis measurement is the most popular among academic radiologists. The volume of cerebral angiography appears to be decreasing. How these data compare with community hospitals without an accredited radiology residency program warrants further study.