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Carotid Artery Stenosis Following Endarterectomy

Carotid Artery Stenosis Following Endarterectomy Abstract • Duplex scanning and spectral analysis were used to detect carotid artery stenosis following 89 endarterectomies in 76 patients with a mean postoperative follow-up interval of 16 months. Operative arteriography was used in all cases to verify the technical result. Spectral changes indicating greater than 50%-diameter internal carotid stenosis were observed postoperatively in 32 of the 89 sides. Serial follow-up on 22 stenotic sides showed persistent stenosis in 12, regression of stenosis in nine, and internal carotid occlusion in one. The estimated overall incidence of persistent high-grade stenosis was 19%. Recurrent neurologic symptoms occurred in eight patients. This incidence of postoperative carotid stenosis is higher than estimates based on clinical criteria. The transient nature of some early postoperative stenosis is consistent with proliferation and regression of myointimal lesions in response to arterial injury. (Arch Surg 1982;117:1408-1415) References 1. Edwards WS, Wilson TAS, Bennet A: The long-term effectiveness of carotid endarterectomy in prevention of strokes . Ann Surg 1968;168: 765-770.Crossref 2. Thompson JE, Austin DJ, Patman RD: Carotid endarterectomy for cerebrovascular insufficiency: Long-term results in 592 patients followed up to 13 years . Ann Surg 1970;172:663-679.Crossref 3. Cossman D, Callow AD, Stein A, et al: Early restenosis after carotid endarterectomy . Arch Surg 1978;113:275-278.Crossref 4. Stoney RJ, String ST: Recurrent carotid stenosis . Surgery 1976;80: 705-710. 5. French BN, Rewcastle NB: Recurrent stenosis at site of carotid endarterectomy . Stroke 1977;8:597-605.Crossref 6. Hertzer NR, Martinez BD, Beven EG: Recurrent stenosis after carotid endarterectomy . Surg Gynecol Obstet 1979;149:360-364. 7. Zierler RE, Bodily KC, Blackshear WM Jr, et al: Current status of ultrasonic duplex scanning of the carotid bifurcation , in Diethrich EB (ed): Noninvasive Cardiovascular Diagnosis . Littleton, Mass, PSG Publishing Co Inc, 1981, pp 33-51. 8. Fell G, Phillips DJ, Chikos PM, et al: Ultrasonic duplex scanning for disease of the carotid artery . Circulation 1981;64:1191-1195.Crossref 9. Breslau PJ, Knox RA, Phillips DJ, et al: The accuracy of ultrasonic duplex scanning as compared with contrast arteriography in extracranial carotid artery disease. Vasc Diagn Ther, in press. 10. Breslau PJ, Fell G, Phillips DJ, et al: Evaluation of carotid bifurcation disease: The role of common carotid artery velocity patterns . Arch Surg 1982;117:58-60.Crossref 11. Thompson JE, Talkington CM: Carotid endarterectomy . Ann Surg 1976;184:1-15.Crossref 12. Kremen JE, Gee W, Kaupp HA, et al: Restenosis or occlusion after carotid endarterectomy: A survey with ocular pneumoplethysmography . Arch Surg 1979;114:608-610.Crossref 13. Turnipseed WD, Berkoff HA, Crummy A: Postoperative occlusion after carotid endarterectomy . Arch Surg 1980;115:573-574.Crossref 14. Roederer GO, Langlois Y, Chan ATW, et al: Post-endarterectomy carotid ultrasonic duplex scanning: Concordance with contrast arteriography. Ultrasound Med Biol, in press. 15. Imparato AM, Bracco A, Kim GE, et al: Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions . Surgery 1972;72:1007-1017. 16. French BN, Rewcastle NB: Sequential morphological changes at the site of carotid endarterectomy . J Neurosurg 1974;41:745-754.Crossref 17. Moore S, Friedman RJ, Gent M: Resolution of lipid-containing atherosclerotic lesions induced by injury . Blood Vessels 1977;14:193-203. 18. Shutz H, Fleming JFR, Awerbuck B: Arteriographic assessment of carotid endarterectomy . Ann Surg 1970;171:509-521.Crossref 19. Diaz FZ, Patel S, Boulos R, et al: Early angiographic changes following carotid endarterectomy . Stroke 1980;11:135. 20. Blaisdell FW, Lim R, Hall AD: Technical result of carotid endarterectomy: Arteriographic assessment . Am J Surg 1967;114:239-246.Crossref 21. McCann RL, Fuchs JCA: Aspirin and dipyridamole decrease intimal hyperplasia in experimental vein grafts . Ann Surg 1980;191:238-243.Crossref 22. Oblath RW, Buckley FO, Green RM, et al: Prevention of platelet aggregation and adherence to prosthetic vascular grafts by aspirin dipyridamole . Surgery 1978;84:37-44. 23. Cossman DV, Treiman RL, Foran RF, et al: Surgical approach to recurrent carotid stenosis . Am J Surg 1980;140:209-211.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Carotid Artery Stenosis Following Endarterectomy

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References (21)

Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1982.01380350016003
Publisher site
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Abstract

Abstract • Duplex scanning and spectral analysis were used to detect carotid artery stenosis following 89 endarterectomies in 76 patients with a mean postoperative follow-up interval of 16 months. Operative arteriography was used in all cases to verify the technical result. Spectral changes indicating greater than 50%-diameter internal carotid stenosis were observed postoperatively in 32 of the 89 sides. Serial follow-up on 22 stenotic sides showed persistent stenosis in 12, regression of stenosis in nine, and internal carotid occlusion in one. The estimated overall incidence of persistent high-grade stenosis was 19%. Recurrent neurologic symptoms occurred in eight patients. This incidence of postoperative carotid stenosis is higher than estimates based on clinical criteria. The transient nature of some early postoperative stenosis is consistent with proliferation and regression of myointimal lesions in response to arterial injury. (Arch Surg 1982;117:1408-1415) References 1. Edwards WS, Wilson TAS, Bennet A: The long-term effectiveness of carotid endarterectomy in prevention of strokes . Ann Surg 1968;168: 765-770.Crossref 2. Thompson JE, Austin DJ, Patman RD: Carotid endarterectomy for cerebrovascular insufficiency: Long-term results in 592 patients followed up to 13 years . Ann Surg 1970;172:663-679.Crossref 3. Cossman D, Callow AD, Stein A, et al: Early restenosis after carotid endarterectomy . Arch Surg 1978;113:275-278.Crossref 4. Stoney RJ, String ST: Recurrent carotid stenosis . Surgery 1976;80: 705-710. 5. French BN, Rewcastle NB: Recurrent stenosis at site of carotid endarterectomy . Stroke 1977;8:597-605.Crossref 6. Hertzer NR, Martinez BD, Beven EG: Recurrent stenosis after carotid endarterectomy . Surg Gynecol Obstet 1979;149:360-364. 7. Zierler RE, Bodily KC, Blackshear WM Jr, et al: Current status of ultrasonic duplex scanning of the carotid bifurcation , in Diethrich EB (ed): Noninvasive Cardiovascular Diagnosis . Littleton, Mass, PSG Publishing Co Inc, 1981, pp 33-51. 8. Fell G, Phillips DJ, Chikos PM, et al: Ultrasonic duplex scanning for disease of the carotid artery . Circulation 1981;64:1191-1195.Crossref 9. Breslau PJ, Knox RA, Phillips DJ, et al: The accuracy of ultrasonic duplex scanning as compared with contrast arteriography in extracranial carotid artery disease. Vasc Diagn Ther, in press. 10. Breslau PJ, Fell G, Phillips DJ, et al: Evaluation of carotid bifurcation disease: The role of common carotid artery velocity patterns . Arch Surg 1982;117:58-60.Crossref 11. Thompson JE, Talkington CM: Carotid endarterectomy . Ann Surg 1976;184:1-15.Crossref 12. Kremen JE, Gee W, Kaupp HA, et al: Restenosis or occlusion after carotid endarterectomy: A survey with ocular pneumoplethysmography . Arch Surg 1979;114:608-610.Crossref 13. Turnipseed WD, Berkoff HA, Crummy A: Postoperative occlusion after carotid endarterectomy . Arch Surg 1980;115:573-574.Crossref 14. Roederer GO, Langlois Y, Chan ATW, et al: Post-endarterectomy carotid ultrasonic duplex scanning: Concordance with contrast arteriography. Ultrasound Med Biol, in press. 15. Imparato AM, Bracco A, Kim GE, et al: Intimal and neointimal fibrous proliferation causing failure of arterial reconstructions . Surgery 1972;72:1007-1017. 16. French BN, Rewcastle NB: Sequential morphological changes at the site of carotid endarterectomy . J Neurosurg 1974;41:745-754.Crossref 17. Moore S, Friedman RJ, Gent M: Resolution of lipid-containing atherosclerotic lesions induced by injury . Blood Vessels 1977;14:193-203. 18. Shutz H, Fleming JFR, Awerbuck B: Arteriographic assessment of carotid endarterectomy . Ann Surg 1970;171:509-521.Crossref 19. Diaz FZ, Patel S, Boulos R, et al: Early angiographic changes following carotid endarterectomy . Stroke 1980;11:135. 20. Blaisdell FW, Lim R, Hall AD: Technical result of carotid endarterectomy: Arteriographic assessment . Am J Surg 1967;114:239-246.Crossref 21. McCann RL, Fuchs JCA: Aspirin and dipyridamole decrease intimal hyperplasia in experimental vein grafts . Ann Surg 1980;191:238-243.Crossref 22. Oblath RW, Buckley FO, Green RM, et al: Prevention of platelet aggregation and adherence to prosthetic vascular grafts by aspirin dipyridamole . Surgery 1978;84:37-44. 23. Cossman DV, Treiman RL, Foran RF, et al: Surgical approach to recurrent carotid stenosis . Am J Surg 1980;140:209-211.Crossref

Journal

Archives of Surgery – American Medical Association

Published: Nov 1, 1982

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