Selection of patients for carotid thromboendarterectomy : the role of magnetic resonance angiography

It has been shown in clinical trials that patients with high grade symptomatic carotid stenosis benefit from carotid thromboendarterectomy. Because of the invasiveness and the costs of intra-arterial digital subtraction angiography, the current standard of reference for the grading of carotid stenosis, magnetic resonance angiography, has become a technique of utmost interest for evaluation of the carotid arteries. The time-of-flight and the newly developed contrast-enhanced magnetic resonance angiography techniques are discussed. At present, we recommend computer enhanced magnetic resonance angiography for screening procedures and for the post-operative follow-up. For pre-operative evaluation we still recommend intra-arterial digital subtraction angiography.