The value of routine computed tomography of the brain in the pre-operative assessment of patients for carotid endarterectomy

Objective. To determine the prevalence of brain infarcts and other intracranial pathology on computed tomography (CT) in patients with greater than 50% internal carotid artery stenosis. Design. Descriptive study of CT findings. Setting. Referral-based cohort at Groote Schuur Hospital. Participants. Sixty-three patients aged 40 - 82 years who had CT of the head prior to carotid endarterectomy. Main outcome measures. Prevalence of brain infarct in patients presenting with transient ischaemic attack (TIA) or stroke, and yield of unsuspected intracranial pathology other than ischaemic necrosis. Results. Brain infarcts were diagnosed in 54% of patients presenting with TIA and in 73% of patients with stroke. True-positive CT scans were present in only 19% and 44% of patients with TIA and stroke, respectively. A single incidental frontal lobe granuloma, unrelated to the patient's clinical presentation, was noted. Conclusions. In the selected group of patients referred for carotid endarterectomy, routine use of CT of the head is not indicated and can be reserved for cases with extraordinary clinical features.