(Ultrasound Review) According to vascular surgeons at the UCLA School of Medicine, when a carotid endarterectomy (CEA) completion study is normal, routine surveillance can be started at one year. Their research was described in an article published in Journal of Vascular Surgery.
Patients with both symptomatic and asymptomatic high-grade carotid stenoses benefit from CEA, there is lowered risk of stroke and consequent decrease in death rate.
"Intraoperative completion carotid evaluation has been advocated to maximize the quality of reconstruction and reduce residual stenosis," they said. Study data supported the finding of a one percent perioperative stroke rate and 3% long-term ipsilateral stroke rate.
All patients had a completion carotid evaluation using either angiography (N=333) or duplex (N=26) or both (N=21). Abnormalities were found in 28 patients and most underwent immediate revision surgery to address the problem. The use of completion studies reduced the department’s restenosis rate during the first six months to 4.5%.
In order to determine the usefulness of a surveillance duplex scan six months after surgery, a study of 377 CEAs was performed. For the purpose of analysis, patients were divided into two groups depending on whether they had a follow-up scan in the first six months following surgery or during the first and second six months following surgery.
"Duplex scans were graded as normal (0%), mild restenosis (1-59%), moderate restenosis (60-79%), and severe restenosis (>80%)," the authors wrote. The ratio between ICA and CCA peak systolic velocities was used to determine the degree of stenosis with a cutoff of 1.9 used for 60-79% and 3.7 for >80%.
In the group that had repeat duplex within six months of CEA there were two moderate recurrent ICA stenoses (0.5%) but no severe ICA stenoses. In the group that had repeat duplex within the first year after CEA there were two patients with severe restenoses (1%) and seven with moderate restenoses. The authors recommended that with a normal completion study duplex, follow-up duplex surveillance can begin at one year after surgery.
"Carotid endarterectomy with normal findings from a completion study: Is there need for early duplex scan?"Carol Pross et al
J D Baker, Gonda Vascular Center, UCLA School of Medicine, Medical Plaza 200, Suite 510-6, Los Angeles, CA 90095, USA
Journal of Vascular Surgery 2001; 33:963-967
By Ultrasound Review
November 6, 2001
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