Completion Arteriogram Following Carotid Endarterectomy Yields Lower Perioperative Stroke Rate

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Neurosurgery

Background:

• The utility of completion imaging after carotid endarterectomy (CEA) is debated.
• Routine completion arteriography (CA) is not universally adopted.
• This study evaluates the impact of routine CA on patient outcomes.

Purpose of the Study:

• To assess the safety and efficacy of routine completion arteriography (CA) following carotid endarterectomy (CEA).
• To determine the rate of intraoperative findings requiring revision.
• To evaluate the impact of routine CA on perioperative stroke and death rates.

Main Methods:

• Retrospective review of a prospectively maintained institutional database.
• Analysis of 1439 isolated CEAs performed with routine CA.
• Data collection included patient demographics, lesion characteristics, arteriographic findings, interventions, and perioperative outcomes.

Main Results:

• No complications were reported related to arteriography.
• Abnormalities requiring revision were identified in 1.7% of cases (e.g., residual stenosis, intimal flaps, kinks, thrombus).
• The overall 30-day stroke, death, and combined stroke/death rates were 1.5%, 0.5%, and 1.9%, respectively, with a lower rate for asymptomatic lesions.

Conclusions:

• Routine completion arteriography (CA) is a safe and simple procedure following carotid endarterectomy (CEA).
• Intraoperative revision based on CA findings may reduce the perioperative stroke rate.
• This study suggests routine CA may have halved the perioperative stroke rate from 3.2% to 1.5%.