Postendarterectomy carotid occlusion

In a prospective study of 300 carotid endarterectomies, ocular pneumoplethysmography (OPG-Gee) was performed in the recovery room after all procedures. Positive test findings, indicative of occlusion of the repaired vessels, were encountered after 16 (5%) of these procedures, and all 16 patients were completely asymptomatic. Serial test results, without angiographic confirmation, have remained positive in nine. Angiography confirmed the positive test results in three. Immediate reoperation, without angiography, confirmed the positive test findings in four, and normal flow was restored in all four cases. Success of carotid endarterectomy should not be measured by absence of symptoms. Objective documentation of persistent patency is essential. Present policy dictates that if recovery room test results are positive, the patient be returned to the operating room as soon as possible, with no delay for angiography.