Therapeutic ultrasound during carotid endarterectomy

Ultrasonography as a diagnostic modality for the diagnosis and surveillance of carotid stenosis has been a mainstay of clinical practice for decades.12 Ultrasound is non-invasive, does not use ionizing radiation or contrast media, and remains low cost, making it an integral evidence based tool for patients with carotid disease.3

Carotid endarterectomy is the surgical therapeutic gold standard to reduce long term stroke risk in patients with severe carotid stenosis. In the linked study (doi:10.1136/bmj-2024-082750), investigators in the SONOBIRDIE trial have tested a new application for ultrasound: prevention of thromboembolic complications during carotid endarterectomy.4 In a multicenter randomized trial of 1004 patients, investigators determined that intraoperative sonolysis with ultrasound at the time of carotid endarterectomy reduced the composite endpoint of transient ischemic attack, stroke, or death within 30 days from 7.6% to 2.2%, compared with sham sonolysis. These findings represent a potentially significant innovation in the application of ultrasound from its historical diagnostic role to now also …