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The importance of intraoperative detection of residual flow abnormalities after carotid artery endarterectomy. J Vasc Surg 1993 May;17(5):912-22; discussion 922-3

Date

05/01/1993

Pubmed ID

8487360

DOI

10.1067/mva.1993.44844

Scopus ID

2-s2.0-0027288584   62 Citations

Abstract

PURPOSE: The efficacy of carotid endarterectomy in the prevention of strokes mandates low perioperative morbidity, as well as a low incidence of late ipsilateral stroke. This prospective study involving 430 patients (461 carotid endarterectomies) correlated the results of intraoperative assessment with end points of stroke and residual/recurrent internal carotid artery (ICA) stenosis.

METHODS: Adequacy of the repair was assessed by ultrasound studies (duplex scan and pulsed Doppler spectral analysis) alone (n = 142), ultrasound studies and arteriography (n = 268), or clinical inspection (n = 51). After operation, duplex ultrasonography was used to confirm patency and categorize severity of ICA stenosis. At operation 26 carotid endarterectomy sites (5.6%), were revised based on intraoperative studies.

RESULTS: Perioperative (30-day) morbidity rates were similar in patients with normal, mildly abnormal, or no ultrasound completion studies. There were six permanent (1.3%) and 12 temporary (2.6%) neurologic deficits and six deaths, including four fatal strokes and two fatal myocardial infarctions. By life-table analysis, the incidence of greater than 50% diameter-reducing ICA stenosis or occlusion was increased (p < 0.007, log-rank test) in patients with residual flow abnormality or no study. More important, patients with normal intraoperative flow studies had a significantly lower rate of late ipsilateral stroke compared with the remaining patient cohort (p = 0.04, log-rank test). During the mean 30-month follow-up interval, the incidence of late stroke was increased (p = 0.00016) in patients with ICA restenosis or occlusion (3/35) compared with patients without recurrent stenosis (3/426).

CONCLUSION: Confirmation of a normal repair at operation affords the best opportunity to minimize ischemic neurologic events and anatomic restenosis after carotid endarterectomy.

Author List

Kinney EV, Seabrook GR, Kinney LY, Bandyk DF, Towne JB

Author

Gary R. Seabrook MD Chief, Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Blood Flow Velocity
Carotid Artery, Internal
Carotid Stenosis
Cerebral Angiography
Cerebrovascular Disorders
Endarterectomy, Carotid
Female
Follow-Up Studies
Humans
Incidence
Intraoperative Care
Life Tables
Male
Middle Aged
Prospective Studies
Recurrence
Time Factors
jenkins-FCD Prod-398 336d56a365602aa89dcc112f077233607d6a5abc