The importance of intraoperative detection of residual flow abnormalities after carotid artery endarterectomy

Kinney, Edward V.; Seabrook, Gary R.; Kinney, Laura Y.; Bandyk, Dennis F.; Towne, Jonathan B.

doi:10.1016/0741-5214(93)90041-j

Cited by 81 publications

(56 citation statements)

References 17 publications

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“…Other authors have also studied the value of duplex scan as an alternative to completion angiography to assess the technical result of CEA. Kinney et al, 23 in a series of 461 CEAs, detected severe residual flow abnormalities in 26 (5.6%) CEAs. Immediate revision was performed without an adverse event in 25 patients, but resulted in a stroke in one revised reconstruction.…”

Section: Discussionmentioning

confidence: 93%

Impact of Routine Completion Angiography on the Results of Primary Carotid Endarterectomy: A Prospective Study in a Teaching Hospital

Ricco

Mothe

Fujita³

et al. 2011

European Journal of Vascular and Endovascular Surgery

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Section: Discussionmentioning

confidence: 93%

Impact of Routine Completion Angiography on the Results of Primary Carotid Endarterectomy: A Prospective Study in a Teaching Hospital

Ricco

Mothe

Fujita³

et al. 2011

European Journal of Vascular and Endovascular Surgery

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“…6 Owing to the significant neurologic morbidity and mortality involved with a failed CEA, however, various intraoperative methods to assess the immediate technical adequacy of this procedure have been developed: continuous-wave Doppler,8 pulsed Doppler,9'10 electromagnetic blood flow measurement,'1 angiography,12'13 and ultrasound.14'15 More recently, duplex ultrasound (DUS), combining B-mode ultrasound imaging with pulsed Doppler spectral analysis, was introduced in an effort to identify lesions following CEA that could lead to perioperative thrombosis and stroke or long-term restenosis. [16][17][18][19] This imaging technique is safe, portable, and noninvasive; requires no contrast media; and allows for the immediate correction of significant technical defects. Its sensitivity in detecting technical defects has been shown to be similar to that of intraoperative angiography,20'21 and with routine use, long-term restenosis rates appear to be decreased.18 '19 The objectives of this study were to examine the technical aspects of intraoperative carotid DUS, to define criteria for differentiating between significant lesions and minor insignificant defects, to evaluate the impact of intraoperative DUS on perioperative neurologic complication rate, and to assess how frequently DUS provides useful information.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative Duplex Ultrasound During Carotid Endarterectomy

Panneton

Berger²,

Lewis

et al. 2001

Vascular Surgery

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The purpose of this study was to examine the technical aspects of intraoperative duplex ultrasound (DUS) following carotid endarterectomy (CEA), suggest criteria to differentiate significant lesions requiring immediate surgical revision from normal or benign defects, and evaluate how frequently intraoperative DUS provides useful or unsuspected information. A retrospective study was performed on all patients who had both CEA and intraoperative carotid DUS between January 1, 1990, and January 1, 1995. A total of 155 DUS examinations were performed in 149 patients. Findings were grouped into three categories: normal; minor/insignificant lesions; and hemodynamically significant lesions based on the presence or absence of elevated peak systolic velocities, visible stenosis/thrombus, or intimal flap/dissection. Postoperative status was correlated with intraoperative DUS findings. Ninety-one (59%) examinations performed on 87 patients produced normal findings. Forty-seven (30%) examinations performed on 45 patients showed minor abnormalities consisting of insignificant residual plaque, residual external carotid artery stenoses, small intimal flaps, elevated velocities with no associated anatomic lesion, or an arterial kink. Fourteen patients (9%) had significant findings requiring immediate surgical revision. These consisted of large intimal flaps or dissection in six patients, marked residual plaque and significant stenosis in five patients, thrombus in two patients, and a kink in one patient. Three additional patients (2%) had significant findings but were not revised for various reasons. No significant difference was identified in morbidity or mortality rates between those patients with normal findings, those patients with minor technical defects, and those patients with significant abnormalities undergoing immediate surgical revision. However, two of three patients who had significant abnormalities within the common carotid artery that were not revised suffered perioperative ipsilateral strokes. Intraoperative DUS is a safe and accurate method to assess the technical adequacy of CEA. Intraoperative DUS showed significant lesions in 11% of patients. Identification and immediate repair of significant technical defects may decrease perioperative complication rate and long-term restenosis rate.

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“…There are only two studies, Healy et al 24 and Kinney et al, 28 in which the 95% confidence interval does not include 1. All other studies have wide confidence intervals including 1.…”

Section: Relative Risk Of Ipsilateral Stroke In Patients With Restenosismentioning

confidence: 99%

Carotid Recurrent Stenosis and Risk of Ipsilateral Stroke

Frericks

Kievit

Baalen

et al. 1998

Stroke

181

108

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Background-The main goal of follow-up after carotid endarterectomy is to prevent new strokes caused by recurrent stenosis.To determine the most cost-effective follow-up schedule, it is necessary to know the incidence of recurrent stenosis and the risk of stroke it carries. Methods-A systematic review of the literature was performed using standard meta-analytical techniques. Results-Incidence of recurrent stenosis: The data were very heterogeneous. The risk of recurrent stenosis was 10% in the first year, 3% in the second, and 2% in the third. Long-term risk of recurrent stenosis is about 1% per year. Risk of stroke: The reported relative risks of stroke in patients with recurrent stenosis compared with patients without recurrent stenosis showed extreme heterogeneity and ranged from 10 to 0.10. The random effects summary estimator of relative risk was 1.88. Conclusions-The data were very heterogeneous, and much better data are needed to arrive at truly reliable estimates of these important parameters of follow-up. It is clear, though, that the risk of recurrent stenosis is highest in the first few years after carotid endarterectomy and very low in later years. By use of general decision-analytic arguments, it can be argued that, given the test characteristics of carotid ultrasound, a small number of tests can be done in the first few years and that testing for restenosis should not be done after 4 years. (Stroke. 1998;29:244-250.)

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The importance of intraoperative detection of residual flow abnormalities after carotid artery endarterectomy

Cited by 81 publications

References 17 publications

Impact of Routine Completion Angiography on the Results of Primary Carotid Endarterectomy: A Prospective Study in a Teaching Hospital

Impact of Routine Completion Angiography on the Results of Primary Carotid Endarterectomy: A Prospective Study in a Teaching Hospital

Intraoperative Duplex Ultrasound During Carotid Endarterectomy

Carotid Recurrent Stenosis and Risk of Ipsilateral Stroke

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