Abstract 2442: Range of Post-operative Findings on CT Angiography For Patients Undergoing CEA

Abstract

Introduction: Carotid endarterectomy (CEA) is an established standard of care for patients with significant carotid stenosis today. Pre-op CTA is now frequently used to evaluate and plan for CEA, however no study to date has examined the findings of routine immediate post-CEA CTA. Aim: The aim of our study is to document the normal and abnormal findings on immediate post-op CTA and evaluate for possible clinical associations. Methods: Registry of all the subjects undergoing CEA, from 1 st July 2008 with available post-CEA CTA. Their medical records were reviewed to record details of the procedure and post-op complications. Results: We found 50 patients with post-CEA CTA, of which 16% had CTA ordered because of postoperative neurological deficit. Nearly 88% of CEAs were performed for symptomatic carotid stenosis/occlusion. All CEAs were performed under general anesthesia, 7 involved shunting and an equal number had patch placement. Only 1 CEA involved an eversion procedure. The mean cross clamp time was 69 minutes (SD 23.7 minutes). On post-CEA CTAs, we found that 78% of subjects had 0-20% residual stenosis, 20% had 20-50% residual stenosis, while 1 subject had 50-69% residual stenosis. A total of 5 subjects had a postoperative stroke. Amongst these, 80% were shunted, 100% had placement of a patch and the mean cross clamp time was 10.8 minutes (SD 15.7 minutes). The most commonly noted abnormality on CTA was a transitional step-off at the most proximal site of endarterectomy in the common carotid artery (CCA) (60% - Panel B). No flap, thrombus, or postoperative stroke was associated with this finding. This finding was associated with longer cross clamp times (76.5 mins v/s 58 mins, p=0.011). A total of 16.3% subjects developed post-op hematoma which resolved without intervention. Postop CTA demonstrated flaps (Panel A) in the ECA in 18% of subjects, in the ICA in 6% of patients, and in the CCA in 10% of patients. All patients with an ICA flap and 66.7% patients with a CCA flap developed a thrombus. All patients with a CCA flap and thrombus developed a post-op stroke, and 66.7% of patients with an ICA flap and thrombus developed a post-op stroke. Conclusion: Common carotid artery step off was the most common finding noted on post-operative CTA, and was not associated with any post-operative stroke. ICA and CCA flaps, seen in a small percentage of patients, were associated with thrombus formation and post-op stroke. This association needs to be further verified in a larger cohort.