Intraoperative ultrasonic imaging of the carotid artery during carotid endarterectomy.
Intraoperative real-time B-mode ultrasonography was used to evaluate the technical results of 155 carotid endarterectomies in 143 patients. Technical defects created as a result of the endarterectomy were detected in 43 of the 155 endarterectomies (27.7%) and included intimal flaps (73% of defects); strictures (18%); and arterial kinks, residual plaque, and intraluminal thrombi (9% collectively). Eleven of the 43 endarterectomy sites (7% of all endarterectomies) were reentered to correct a defect; none of these patients had neurologic deficits, which suggests that reentering an endarterectomy and correcting a defect does not, in and of itself, lead to a higher incidence of stroke. The incidence of stroke in patients with normal results of intraoperative ultrasonography was 3.8%, whereas the incidence of perioperative stroke in those patients with insignificant and thus uncorrected defects was 3.3%; this suggests that intraoperative ultrasonography is sufficiently sensitive to detect defects that, when left uncorrected, do not lead to a higher than usual incidence of stroke. Because intraoperative ultrasonography is safe and highly sensitive, we believe it is the method of choice for assessing the technical results of carotid endarterectomy.
D000328:Adult; D000368:Aged; D002339:Carotid Arteries / Q000473:pathology / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D004691:Endarterectomy; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D014463:Ultrasonography