Routine intraoperative carotid angiography: Its impact on operative morbidity and carotid restenosis

Eight-year experience with carotid artery stenting for correction of symptomatic and asymptomatic post-endarterectomy defects

“…9,11 Many authors consider complete thrombosis or partial thrombosis with distal embolization as the natural outcome of these technical errors, thus implying the important role of intraoperative quality check and early correction of both symptomatic and asymptomatic defects. [9][10][11][21][22][23] On the other hand, other authors claim that asymptomatic defects are rather benign and self limiting, thus requiring no correction. 20,24,25 Moreover, other authors have shown that a symptomatic post-CEA defect is still correlated to a rather poor prognosis, even after correction, 26 thus questioning the role of revisional surgery.…”

Blowout of Carotid Venous Patch Angioplasty

“…In a series of 250 carotid endarterectomies reported by Ban-dyk and associates [13], nine of the 10 intraoperative revisions for flow abnormalities (4% of all endarterectomized arteries) had undergone primary closure of their arteriotomy. For these and other authors [2,3,6,9,10,12], vein patching is associated with superior results and patency rates after endarterectomy, offering protection against early thrombosis and late recurrent stenosis. The benefits of vein patch angioplasty seem to be more striking in women [9].…”

“…The venous endothelium has been reported to enhance reendot-helialization of the denuded media and to avoid intimal fibroplasia [5,[9][10][11]. Patch angioplasty restores normal contour to the carotid bulb with minimal flow disturbances [2,4,7,8,12]. In a series of 250 carotid endarterectomies reported by Ban-dyk and associates [13], nine of the 10 intraoperative revisions for flow abnormalities (4% of all endarterectomized arteries) had undergone primary closure of their arteriotomy.…”

“…Technical considerations are of paramount importance in carotid surgery. The arteriotomy should be prolonged beyond the distal margin of the plaque, enabling visual control of the smooth feathering-off of the lesion at its end point on the posterior wall of the internal carotid artery [4,8,9,[12][13][14][17][18][19][20]. Primary closure should be performed only for short endarterectomies in large arteries.…”

“…Primary closure should be performed only for short endarterectomies in large arteries. For closure of an internal carotid artery of less than 4 mm in diameter, a small (3 to 4 mm) trimmed onlay patch, beveled at one end, is mandatory if compromise of the lumen is to be avoided [4,5,7,12,18,21,22]. Care must be exercised not to enlarge the vessel excessively.…”