Correlation of postoperative and two-year follow-up angiography with neurological function in 99 carotid endarterectomies in 86 consecutive patients.
Eighty-six consecutive patients in 1982 underwent 99 endarterectomies and routine postoperative digital subtraction angiography. Ten vessels were closed primarily and 89 with a patch graft. Minor morbidity was 2%, major morbidity 0%, and mortality 1%, but these varied according to the patient's preoperative medical and neurological function and angiographic findings. Postoperative patency for the common carotid artery (CCA) and internal carotid artery (ICA) was 100% and for the external carotid artery (ECA) 97%. Seventy-nine vessels were evaluated by a DSA 2 years after surgery. There was one asymptomatic occlusion in follow-up and one symptomatic re-stenosis in a patient with a proven heparin induced hypercoagulability state. The three postoperative ECA occlusions were associated with a lethal postoperative stroke, the only ICA occlusion in follow-up, and a 50% stenosis of the CCA in follow-up at the site of ECA occlusion. Vein patch grafting protected the ICA but not the CCA from recurrent stenosis. The carotid slim sign on preoperative angiograms is judged to indicate a patient at high risk of stroke morbidity.
D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000601:surgery; D002342:Carotid Artery, External / Q000000981:diagnostic imaging; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging; D004691:Endarterectomy; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D012008:Recurrence