Angioscopy

Abstract

There is much controversy as to whether monitoring and quality control can influence outcomes after carotid endarterectomy (CEA). This is despite the fact that most intra-operative strokes follow inadvertent technical error. One important reason why the controversy persists is because previous studies have usually tried to identify one single imaging/monitoring modality that can prevent all peri-operative strokes. Clearly, this is an illogical attitude to adopt as there are a multitude of reasons why strokes occur, and it is naïve to assume that one single monitoring or quality control strategy can prevent all strokes that are destined to occur. For example, how could you expect electroencephalography (EEG) to prevent a stroke due to embolisation of retained luminal thrombus following restoration of flow? EEG is a monitoring strategy that can only tell the surgeon that something has gone wrong after the event. You need to adopt another pre-emptive quality control (i.e. not monitoring) strategy to identify and remove thrombus before it can embolise to the brain.