ABSTRACT
Carotid endarterectomy is well established in the treatment of selected cases of atherosclerosis of the carotid bifurcation but the incidence of restenosis is unknown. During a four year period 80 endarterectomies of the internal carotid artery were performed in 73 patients. Post-operatively we studied our patients prospectively by means of Doppler ultrasound in combination with real time spectral analysis and where indicated digital venous angiography to determine the incidence of restenosis. We report a 12.5% incidence of stenosis following carotid endarterectomy with a 1% incidence of symptomatic restenosis. We therefore question the role of carotid endarterectomy in the treatment of asymptomatic carotid stenosis.
Subject(s)
Arteriosclerosis/surgery , Carotid Artery Diseases/surgery , Carotid Artery, Internal/surgery , Endarterectomy , Aged , Carotid Arteries/diagnostic imaging , Carotid Artery Diseases/diagnostic imaging , Carotid Artery Diseases/etiology , Constriction, Pathologic/etiology , Endarterectomy/mortality , Female , Humans , Male , Middle Aged , Radiography , Recurrence , Subtraction TechniqueABSTRACT
Carotid endarterectomy is established in the treatment of atherosclerosis of the carotid bifurcation, but the incidence of restenosis and the role of endarterectomy in the management of asymptomatic carotid stenosis are variable. During a four-year period, we performed 80 endarterectomies of the internal carotid artery in 73 patients. Patients were prospectively studied by means of Doppler ultrasonography in combination with real-time spectral analysis to determine the incidence of restenosis postoperatively. A concomitant study of 116 patients with 79 asymptomatic carotid stenoses was undertaken. We found a 12.5% incidence of stenosis following carotid endarterectomy and a 3% risk of transient neurologic deficit in the patients with asymptomatic carotid stenoses.
Subject(s)
Arterial Occlusive Diseases/epidemiology , Carotid Artery Diseases/epidemiology , Endarterectomy/adverse effects , Aged , Arterial Occlusive Diseases/diagnosis , Arterial Occlusive Diseases/etiology , Carotid Artery Diseases/diagnosis , Carotid Artery Diseases/etiology , Carotid Artery, Internal/surgery , Cerebrovascular Disorders/epidemiology , Endarterectomy/mortality , Female , Humans , Ireland , Ischemic Attack, Transient/epidemiology , Male , Middle Aged , Recurrence , Spectrum Analysis , UltrasonographyABSTRACT
In a one year period, 400 patients were examined by carotid ultrasonic arteriography combined with real time sound spectral analysis. Contrast arteriography was performed on 112 patients. The noninvasive examinations and contrast arteriograms of these patients were reviewed by two independent observers, who were unaware of the findings of the other diagnostic modality. There were 190 vessels available for comparison. The internal carotid artery was classified as normal, less than 50% stenosis, greater than or equal to 50% stenosis, or occluded. The specificity of these non-invasive tests was 79%. The sensitivity in correctly identifying stenoses as less than 50% or greater than or equal to 50 was 85% and 91% respectively. The sensitivity in identifying occluded vessels was 90%. The positive and negative predictive values were 87% and 92% respectively. Noninvasive evaluation correctly identified six lesions misdiagnosed by arteriography. We found pulsed Doppler arteriography combined with real time spectral analysis to be an accurate, direct, noninvasive method of assessing the extracranial carotid arteries.
