Assessment of intraoperative duplexsonography during carotid endarterectomy

Introduction: Carotid endarterectomy (CEA) for prevention of strokes mandates a high amount of experience and a meticulous surgical technique. Intraoperative morphologic as well as hemodynamic monitoring of the endarterectomized arteries is rarely performed. The purpose of this study was to determine the value of intraoperative colour-coded-duplex-sonography to recognize eventual intraoperative technical problems that might result in serious cerebral damage. Methods: Prospective analysis of the medical data of all patients who underwent CEA for treatment of high-grade carotid stenosis between 1996 and 1999. Adequacy of the repair was assessed intraoperatively by duplexsonography. Results: Of 142 consecutive patients with a median age of 68 (43-84) years, 104 (73%) were men and 38 (27%) were women. 9 patients (6%) had bilateral CEAs. intraoperative duplexsonography revealed abnormalities during 11 (7%) of 151 CEAs. 4(3%) were considered major and underwent immediate revision. There was one (0.7%) temporary neurologic deficit (hyperperfusion syndrome) and 2 (1.3%) cases of fatal intracerebral hemorrhage. 6 (4%) postoperative surgical complications occurred, i.e. 3 cases of major wound hematoma (with revision) and 3 cases of temporary cranial nerve palsy. Median length of follow-up was 11 (3-35) months. No late neurologic event occurred during follow-up. 5 (3%) patients developed asymptomatic restenosis. Discussion: Routine intraoperative duplexsonography is a valuable and reliable diagnostic tool to detect correctable technical problems during CEA that subsequently may lead to neurological deficits, fatal stroke or a high incidence of restenosis.