Impact of completion angiography on operative conduct and results of carotid endarterectomy.
OBJECTIVE
This study assessed the impact of operative completion angiography on conduct and results of carotid endarterectomy (CEA).


BACKGROUND
Completion imaging by angiography, ultrasound or angioscopy reveals occasional residual lesions after CEA. The importance and appropriate management of these lesions remain controversial with respect to operative morbidity and long-term restenosis.


METHODS
Carotid endarterectomy was performed 410 times for transient ischemic attack (44%), amaurosis fugax (19%), prior stroke (10%), and asymptomatic carotid stenosis (27%). Routine intraoperative completion angiograms were obtained to exclude significant residual lesions. Postoperative ultrasound follow-up was obtained in 232 patients over a mean interval of 17.3 months.


RESULTS
Angiography revealed 71 defects warranting correction in 66 cases (16.1%), including kinks (23), external carotid flaps (18), common carotid plaque (10), thrombus (10), distal internal carotid stenosis (8), intracranial occlusion (1), and spasm (1). Operative morbidity included seven ipsilateral strokes (1.7%) and operative mortality was 0.7%. During follow-up, restenosis > 80% was detected in 17 (7.3%) of 232 arteries, 9 (3.9%) of which underwent reoperation. Rates of restenosis of > 80% were similar between sexes and patched versus unpatched arteries.


CONCLUSIONS
Routine completion angiography after CEA guides use of selective operative revision contributing to low rates of perioperative morbidity and restenosis.
Donaldson
M C
MC
Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
Ivarsson
B L
BL
Mannick
J A
JA
Whittemore
A D
AD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D001766:Blindness / Q000601:surgery; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000601:surgery; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002546:Ischemic Attack, Transient / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011183:Postoperative Complications; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014654:Vascular Patency