Prospective assessment of carotid endarterectomy by clinical and ultrasonic methods

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Abstract
Sixty-three carotid endarterectomies in 60 patients were followed by clinical and duplex scanning at 2 weeks postoperatively and at 3-monthly intervals for 3 years (mean 18 months). Four patients died (two of stroke, two of myocardial infarction) and four survivors had recurrent ipsilateral symptoms. Two had an immediate mild hemiparesis which recovered completely within 36 h; in both, the endarterectomized arteries were patent on scanning. The other two experienced amaurosis fugax for 2–3 weeks at 2 and 24 weeks; scanning showed that the sites of both endarterectomies had become occluded. Ultrasound assessment at 2 weeks showed that 43 of 61 (70·5 per cent) endarterectomized arteries were widely patent. There were three occlusions, one stenosis of > 75 per cent, three stenoses of > 50 per cent and eleven stenoses of < 50 per cent. At 6 months a total of five vessels were occluded, with > 75 per cent stenosis in three and > 50 per cent stenosis in eight. At latest follow-up, six of eight arteries with > 50 per cent stenosis shown earlier had scans which had reverted to normal. Tacking down of the distal intima was associated with higher incidence of restenosis and occlusion (P < 0·01). Women were more predisposed to restenosis by neointimal hyperplasia (P < 0·05). All restenosis occurred within the first 6 months postoperatively (26·2 per cent) and fell to 16·4 per cent at the end of the study.