One year of prospective follow-up after carotid thrombendarterectomy--a clinical and duplex study

The aim of this study was to make a prospective evaluation of the carotid arteries after thrombendarterectomy by combined clinical and duplex examination, to define an exact time of development of postoperative restenosis/occlusion and to relate early morphological changes to occurrences of new neurological events.

Sixty-four patients (66 operations), 48 men and 16 women, mean age of 63+/-8 (SD) years, with transient ischaemic attacks or minor stroke were examined clinically 1 day before and after the carotid surgery. All except 3 patients had stenosis > or =50%. Duplex scanning and periorbital Doppler were performed before aortic arch angiography, within 2 weeks after operation and thereafter at 3, 6 and 12 months.

10 patients experienced minor stroke and one major stroke after operation, in 5 patients connected with occlusion on the operated side, which differed (P<0.01) from 56 patients with open vessels in whom 6 ipsilateral minor strokes occurred. Four of 6 patients with minor stroke, in whom the operated vessels were open, recovered, whereas the neurological deficits were permanent in all 5 patients with occlusion (P<0.05). Duplex scanning confirmed 10 new occlusions and 2 high grade stenoses >75% postoperatively. Persisting morbidity was 11% and no mortality at 3 months' control. At 12 months' control, 1 patient had stroke related to preoperatively diagnosed occlusion on the non-operated side and 14 flow reducing lesions >75% (11 occlusions and 3 stenoses >75%) were found in 57 (24.6%) of examined vessels.

occlusion occurs in immediate postoperative period and seems to be a serious complication connected with significantly higher number of persistent neurological events than open vessels.