Evaluating the Role of Same-Day Repeat Duplex Ultrasound in Surgical Decision-Making for Carotid Endarterectomy

Background and objective Carotid artery stenosis is a major cause of ischemic stroke and transient ischemic attack. Timely carotid endarterectomy (CEA) reduces the risk of recurrent stroke in appropriately selected symptomatic patients. However, stenosis severity may change between diagnosis and surgery following initiation of best medical therapy (BMT), potentially influencing operative decision-making. The objective of this study is to evaluate the impact of routine same-day repeat duplex ultrasound as part of a structured preoperative pathway for patients scheduled for CEA, focusing on the detection of plaque regression following BMT and its influence on surgical planning and cancellation. Methods This single-center retrospective observational study was performed at University Hospitals Coventry and Warwickshire between January 1, 2019, and June 1, 2021. Duplex ultrasound scans were performed at initial assessment and repeated on the day of surgery. Stenosis severity was classified using institutional reporting standards incorporating peak systolic velocity and velocity ratio criteria. Regression analysis was based on reported percentage stenosis values. Results A total of 107 patients were included. Surgery was canceled in 11 patients (10.4%), including two patients (1.9%) in whom same-day duplex ultrasound demonstrated regression of stenosis below 50%. Overall stenosis categorization remained unchanged in most patients; however, 17 patients (15.9%) demonstrated regression greater than 5% between scans. Among the 96 patients who underwent CEA, 30-day outcomes were favorable, with one stroke (1.0%), two hematomas requiring evacuation (2.1%), and no deaths. Conclusions Same-day repeat duplex ultrasound changed operative management in a small proportion of patients, with regression sufficient to change indication occurring exclusively in those with moderate (50-69%) baseline stenosis. These findings suggest that routine rescanning may not be necessary, but selective repeat imaging near treatment thresholds may be reasonable.