Carotid endarterectomy (CE) of the internal carotid artery (ICA) with and without patch angioplasty: comparison of hemodynamical and morphological parameters.
The aim of this study was to show, if patch angioplasty or direct closure of the blood vessel following carotid endarterectomy of the ICA resulted in any hemodynamical or morphological differences. Studies were carried out in eighteen and twenty patients, respectively within an average postoperative period of twenty-six month. All patients were examined with continuous-wave Doppler ultrasound, multi-channel pulse Doppler ultrasound and Duplex ultrasonography scanning. Comparing the two groups, differences are predominantly found at or near the site of the endarterectomized segment. Patients who received PTFE (Gore-Tex) patch angioplasty to close the arteriotomy, show in about 50% of all cases a dilatation--pantaloon effect (10)--at the carotid bifurcation (lumina greater than 1.1 cm) when investigating the vessel lumen with duplex sonography. This results in a statistical significant increase in turbulent flow disturbances at the bulb and the origin of the ICA. Furthermore, ICA flow velocity patterns after the endarterectomy point are still within the normal range when compared with patients not receiving a patch plasty, but still significantly elevated. Changes of the vessel wall, as such as intima elevation and intraluminal deposits are more frequently found distal to the endarterectomized segment and do obviously reduce the lumen. However, changes of flow volumina were not quantifiable. Atherosclerotic patients who underwent surgical treatment show as a characteristic finding due to atherosclerosis, a less laminar flow-pattern within the whole extracranial area, when compared with a normal healthy population.
Hirschl
M
M
Clinic of Neurosurgery, University of Vienna, Austria.
Bernt
R A
RA
Hirschl
M M
MM
D000368:Aged; D001783:Blood Flow Velocity; D001807:Blood Vessel Prosthesis; D002339:Carotid Arteries / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002343:Carotid Artery, Internal; D004691:Endarterectomy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009915:Orbit / Q000098:blood supply; D014463:Ultrasonography