Surveillance imaging of the operated artery does not alter clinical outcome following carotid endarterectomy.
Clinical outcome was studied in 243 patients undergoing 260 carotid endarterectomies; 166 of these patients underwent serial postoperative surveillance imaging. Including perioperative events, cumulative freedom from ipsilateral stroke was 86 and 82 per cent at 5 and 10 years respectively; the mean incidence of ipsilateral stroke was 1.8 per cent per annum. Twenty patients (8 per cent) suffered cerebral ischaemic events in the hemisphere of the operated side during follow-up: eight transient ischaemic attacks (TIA) and 12 strokes (only two preceded by TIA). Two symptomatic patients were found to have occluded the operated artery but the remainder had no evidence of significant recurrent disease. Cumulative freedom from occlusion or severe (greater than 70 per cent) recurrent stenosis was 87 and 78 per cent at 5 and 10 years respectively; the mean incidence of recurrence of significant disease was 2.2 per cent per annum. No revisional surgery was performed on the operated arteries. In its current format, neither clinical nor surveillance imaging could have prevented any of the strokes observed during follow-up.
Naylor
A R
AR
Department of Vascular Surgery, Edinburgh Royal Infirmary, UK.
John
T
T
Howlett
J
J
Gillespie
I
I
Allan
P
P
Ruckley
C V
CV
D015901:Angiography, Digital Subtraction; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000601:surgery*; D002561:Cerebrovascular Disorders / Q000209:etiology; D015331:Cohort Studies; D016894:Endarterectomy, Carotid; D005500:Follow-Up Studies; D006801:Humans; D011182:Postoperative Care; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome