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Duplex morphologic features of the reconstructed carotid artery: changes occurring more than five years after endarterectomy. J Vasc Surg 1997 May;25(5):850-6; discussion 856-7

Date

05/01/1997

Pubmed ID

9152312

DOI

10.1016/s0741-5214(97)70214-3

Scopus ID

2-s2.0-0030915149   14 Citations

Abstract

PURPOSE: To determine the late morphologic appearance of the carotid artery after endarterectomy and to relate the morphologic characteristics to the development of recurrent carotid stenosis and subsequent neurologic symptoms.

METHODS: Eighty-eight carotid reconstructions (51% included patch angioplasty) in 82 patients were studied 5 or more years after carotid endarterectomy. Duplex color flow imaging was used to determine morphologic characteristics of the carotid endarterectomy site and to document the occurrence, time interval, and progression of recurrent internal carotid artery stenosis. The spatial orientation of recurrent wall thickening, presence of calcium, arterial wall texture, and presence of laminar flow were evaluated. Recurrent stenoses were categorized using standard duplex criteria.

RESULTS: The mean duration of follow-up was 99 months (range, 60 to 138 months). Arterial wall calcium was identified in 23% (n = 18), a smooth luminal surface in 57% (n = 46), and laminar flow in 52% (n = 42). Recurrent wall thickening developed in 58 vessels (66%), involving the posterior segment of the vessel in 95%, and anterior, lateral, or medial aspects in 24% (n = 14). Restenosis > 50% diameter reduction occurred in 4% of common carotid arteries (n = 3) and in 15% of internal carotid arteries (n = 13). Ten of the internal carotid artery restenoses occurred after a mean of 76 months (range, 13 to 132 months), and the three remaining patients had asymptomatic occlusions after a mean of 61 months (range, 1 to 96 months). Neurologic events referable to the reconstructed carotid artery occurred in three patients at a mean of 77 months; two were a result of recurrent carotid disease. One symptomatic patient and two asymptomatic patients (3.7%) underwent a second ipsilateral reconstruction for recurrent high-grade stenosis.

CONCLUSIONS: The carotid artery remains smooth, with laminar flow and without calcification, in the majority of reconstructions that were observed over a long term. There is a low incidence of subsequent ipsilateral neurologic events or significant recurrent stenosis, both of which usually occur late in the postoperative period. This study documents the long-term durability of carotid endarterectomy in providing risk reduction for stroke.

Author List

Coe DA, Towne JB, Seabrook GR, Freischlag JA, Cambria RA, Kortbein EJ

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

Aged
Aged, 80 and over
Carotid Artery, Common
Carotid Artery, Internal
Carotid Stenosis
Endarterectomy, Carotid
Female
Follow-Up Studies
Humans
Incidence
Male
Middle Aged
Prospective Studies
Recurrence
Time Factors
Ultrasonography, Doppler, Color
jenkins-FCD Prod-398 336d56a365602aa89dcc112f077233607d6a5abc