Noninvasive carotid artery evaluation following endarterectomy

There has been recent interest in carotid restenosis following endarterectomy. To evaluate the significance of this complication, 2549 consecutive patients who were evaluated for suspected carotid artery occlusive disease by carotid phonoangiography, ocular plethysmography, and B-mode scanning techniques over a 21-month period were reviewed. Within this group a total of 155 patients had previously undergone a carotid endarterectomy. Of these, only four patients manifested clinically significant restenosis. In the majority of patients the carotid bifurcation was free of significant disease. The "carotid shelf" that represents the superior aspect of residual intimal plaque following endarterectomy could be clearly identified in the early postoperative period; however, it later blended to become less distinct. In a few instances, however, the amount of residual plaque at the lower extent of the endarterectomy was very prominent and remained so during follow-up studies, suggesting the possibility that this might represent a focus for future thrombosis. We conclude that noninvasive testing as used herein is an accurate method of assessing the carotid artery following endarterectomy. The accuracy of these techniques has been of such high degree that 16 carefully selected patients have subsequently undergone carotid endarterectomy without preoperative angiography.