[Will carotid thromboendarterectomy remain competitive? Influence of intraoperative duplex ultrasound quality
H W Kniemeyer1, C Sporkmann, H Beckmann
1Klinik für Gefässchirurgie und Phlebologie, Elisabeth-Krankenhaus Essen, Klara Kopp Weg 1, 45138 Essen. h.w.kniemeyer@elisabeth-essen.de
Insights
Routine intraoperative duplex ultrasound during carotid endarterectomy (TEA) helps detect and fix issues, improving outcomes. This technique is vital for reducing complications in carotid artery disease treatment.
Area of Science:
- Vascular Surgery
- Diagnostic Imaging
- Interventional Cardiology
Context:
- Carotid artery lesions pose significant stroke risk.
- Thromboendarterectomy (TEA) and stenting are primary treatment options.
- Improving the safety and efficacy of carotid interventions is crucial.
Purpose:
- To evaluate the impact of routine intraoperative duplex ultrasound on carotid endarterectomy outcomes.
- To assess the rate of intraoperative findings and their impact on patient management.
- To compare complication rates in patients undergoing carotid TEA with and without routine intraoperative ultrasound.
Summary:
- A prospective study of 620 carotid operations found routine intraoperative duplex ultrasound identified unexpected lesions in 10% of cases, prompting immediate repair.
- The overall morbidity/mortality rate was 2.6%, with a neurological complication rate of 1.6%.
- Specific patient groups like women showed a higher risk (4.2%), while elderly patients (>75 years) had a low risk.
Impact:
- Routine intraoperative duplex ultrasound enables timely diagnosis and correction of morphologic and hemodynamic issues during carotid reconstruction.
- This technique offers a potential pathway to further reduce complications associated with carotid TEA, making it more competitive with stenting.
- Enhanced quality control through intraoperative imaging can improve patient safety and surgical outcomes in carotid interventions.
Background:
Thromboendarterectomy (TEA) and stenting are in competition for treatment of carotid artery lesions. Both treatment modalities have to improve significantly. The goal of the study was to evaluate the influence of routine intraoperative duplex ultrasound examination.
Methods:
In a continuous prospective study, 575 patients underwent 620 carotid operations. Intraoperative duplex ultrasound examination was performed prior to wound closure: 9.5% had significant contralateral ICA stenoses and 6.7% ICA occlusion; 8.5% presented special lesions. An eversion TEA was performed in 20.5% while 78.5% underwent conventional TEA with patch plasty and graft interposition in 1%. Intraoperative quality control revealed unexpected lesions in 10% requiring immediate repair.
Results:
The combined morbidity/mortality rate (MMR) of the total series was 2.6%. Women had an elevated risk (4.2%) in comparison to men (1.9%). The risk of elder patients (>75 years, n=151) was remarkably low. The neurological complication rate of the total series was 1.6% and the incidence of major strokes 1.1%.
Conclusions:
Routine intraoperative duplex ultrasound examination of the carotid reconstruction allows early diagnosis and immediate correction of morphologic as well as hemodynamic lesions. Competing with stent placement a further reduction of complications of carotid TEA seems to be possible and necessary.
