Technical result of carotid endarterectomy

Blaisdell, F. William; Lim, Robert C.; Hall, Albert D.

doi:10.1016/0002-9610(67)90378-9

Cited by 141 publications

(18 citation statements)

References 16 publications

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“…Blaisdell et al 6 followed 100 patients over 5 years. Follow-up arteriography, 10-60 days after sur- gery, was available in 95 patients and demonstrated 1 occlusion (1%).…”

Section: Discussionmentioning

confidence: 99%

Carotid restenosis: long-term noninvasive follow-up after carotid endarterectomy.

DeGroote¹,

Lynch²,

Jamil³

et al. 1987

Stroke

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Recurrent stenosis has not been a primary consideration in the selection of patients for carotid endarterectomy. We have studied the incidence of postoperative restenosis retrospectively in 265 patients following 310 carotid endarterectomies. Two hundred fourteen patients (248 endarterectomies) were examined at 6-12 month intervals using ocular pneumopiethysmography, spectral analysis, and B-mode imaging. The absolute incidence of recurrent carotid disease was 28% (69 of 248), with a 13% (33 of 248) incidence of hemodynamically significant restenosis and a 15% (36 of 248) incidence of hemodynamically insignificant disease. Life table analysis of the data projected a 32% incidence of hemodynamically significant restenosis after 7 years and a 40% incidence of hemodynamically insignificant recurrence. These data demonstrate a progressively increasing rate of restenosis. The incidence of ipsilateral neurologic events was 8% (24 of 310); 12 occurred in association with noninvasively evident recurrent disease (12 of 69, 17%), whereas 11 occurred in noninvasively determined normal arteries (11 of 179,6%). Noninvasive follow-up was not available in 1 patient. Of the 12 events associated with recurrent disease, 5 occurred in association with hemodynamically significant restenosis (5 of 33,15%), whereas 7 occurred in association with hemodynamically insignificant disease (7 of 36,19%). Carotid endarterectomy is a durable operative procedure with 92% (286 of 310) of arteries remaining asymptomatic over the period of clinical follow-up. However, absolute and life table projections of the incidence of asymptomatic restenosis are high, and this factor should be considered in the selection of patients for carotid endarterectomy, particularly in the absence of lateralizing symptoms. (Stroke 1987; 18:1031-1036) R ecurrent stenosis following carotid endarterectomy has been described previously.'-" The .. incidence of restenosis, however, remains variable, dependent on the methods of diagnosis and the inclusion of asymptomatic as well as symptomatic recurrence. Stoney and String 1 reported a 1.9% incidence of recurrent disease based on recurrent symptoms, whereas Nicholls et al 2 and O'Donnell and Callow 3 have documented recurrence rates of 12-22% based on the results of noninvasive diagnostic techniques. The implications of these data are significant and relevant to the determination of operative indications in symptomatic and asymptomatic patients.The technologic improvements in noninvasive diagnostic methods have provided safe and practical means of following patients after carotid endarterectomy. The purpose of this report is to determine the incidence of restenosis in patients undergoing carotid endarterectomy for symptomatic and asymptomatic lesions, using oculoplethysmography and ultrasonography. Data were assessed using life table analysis for a 5-7-year period of clinical follow-up.

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“…Blaisdell et al 6 followed 100 patients over 5 years. Follow-up arteriography, 10-60 days after sur- gery, was available in 95 patients and demonstrated 1 occlusion (1%).…”

Section: Discussionmentioning

confidence: 99%

Carotid restenosis: long-term noninvasive follow-up after carotid endarterectomy.

DeGroote¹,

Lynch²,

Jamil³

et al. 1987

Stroke

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“…Our incidence of symptomatic recurrence is 4.5%, while others report between 1% and 7%. [3][4][5][6][7][8][9] The cause of restenosis is not completely understood. Technical errors at the time of the original operation were thought to be the cause of restenosis in six of our 21 patients.…”

Section: Resultsmentioning

confidence: 99%

Noninvasive Detection of Carotid Stenosis Following Endarterectomy

Cantelmo¹

1981

Arch Surg

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“…Carried out as a matter of routine, this test provides indication of the need for immediate CE correction in variable though significant percentages, between 5 % and 25 % approximately. 5,8,[15][16][17][18][19][20][21][22] It also permits detection of spasms distal to the arteriotomy, which are a possible cause of acute thrombosis.23…”

Section: Discussionmentioning

confidence: 99%

Surgical Techniques from Intraoperative Angiographic and Velocimetric Controls in 43 Consecutive Carotid Bifurcation Endarterectomies

et al. 1988

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From January to November, 1985, 43 carotid bifurcation endarterectomies (CE) were performed with intraoperative functional (Doppler spectrum analysis) and morphologic (angiography) controls.In the first 20 cases, after thromboendarterectomy and direct suture, Doppler showed absence of or no significant variations of frequency in 17 cases, a frequency increase corresponding to a less than 45% diameter reduction stenosis at the apex of the suture in 2 cases, and no flow in the internal carotid artery (ICA) in 1 case. Angiography confirmed the thrombosis in the above mentioned case and showed 3 less than 50% stenoses at the distal end of the arteriotomy: 2 already recognized by Doppler in small-size ICAs and 1 in a medium-size ICA without significant changes of flow. The reason for thrombosis was a distal intimal flap, which was successfully removed; the 2 stenoses in which Doppler and angiography agreed were corrected by patch angioplasty. In the last 23 cases, patch angioplasty was performed routinely in small-size ICAs (6 cases); in 1 case, first treated by a direct suture, Doppler and angiography showed a medium-grade stenosis, immediately corrected; in 1 case both techniques showed a 50% stenosis in a common carotid artery, immediately corrected.The execution of intraoperative angiography in this group of patients allowed the authors to define the indication for the use of patch angioplasty, never at MICHIGAN STATE UNIV LIBRARIES on June 8, 2015 ves.sagepub.com Downloaded from 94 previously employed. Nevertheless, the authors state that, on account of loss of time, costs, and exposure to radiations, intraoperative angiography must be reserved for those cases selected by Doppler spectrum analysis. This method seems to be highly sensitive in recognizing significant technical defects that could lead to an immediate or late failure.

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Technical result of carotid endarterectomy

Cited by 141 publications

References 16 publications

Carotid restenosis: long-term noninvasive follow-up after carotid endarterectomy.

Carotid restenosis: long-term noninvasive follow-up after carotid endarterectomy.

Noninvasive Detection of Carotid Stenosis Following Endarterectomy

Surgical Techniques from Intraoperative Angiographic and Velocimetric Controls in 43 Consecutive Carotid Bifurcation Endarterectomies

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