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Routine postendarterectomy duplex surveillance: does it prevent late stroke?

W C Mackey1, M Belkin, R Sindhi

  • 1Department of Surgery, Tufts University School of Medicine, Boston, MA.

Journal of Vascular Surgery
|December 1, 1992
PubMed
Summary
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Routine duplex surveillance after carotid endarterectomy is not justified for preventing late strokes. Most recurrent carotid stenosis detected does not lead to stroke, questioning the utility of this surveillance method.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Diagnostic Imaging

Background:

  • Late strokes after carotid endarterectomy are often unrelated to recurrent stenosis.
  • The effectiveness of routine postendarterectomy duplex surveillance (RpCEADS) in preventing these strokes is uncertain.

Purpose of the Study:

  • To evaluate the utility of RpCEADS in preventing late strokes.
  • To correlate duplex surveillance findings with clinical outcomes after carotid endarterectomy.

Main Methods:

  • Retrospective review of 1053 duplex scans from 348 carotid arteries in 258 patients.
  • Analysis of scan results and correlation with clinical data over an average follow-up of 52.6 months.

Main Results:

  • Recurrent carotid stenosis (<50%) was found in 83.9% of arteries.

Related Experiment Videos

  • Significant stenosis (>50%) or occlusion occurred in 16.1% of arteries.
  • Only 3.6% of detected stenoses directly caused unheralded stroke; others were asymptomatic or led to transient ischemia.

    • Conclusions:

    • RpCEADS is not justified as a strategy for preventing late strokes related to recurrent carotid stenosis.
    • The low incidence of stroke directly attributable to detected recurrent stenosis undermines the routine use of surveillance.