title: Spontaneous echo contrast and thrombus formation at the carotid bifurcation after carotid endarterectomy.
abstract: Spontaneous echo contrast (SEC) consists of numerous microechoes swirling in the cardiovascular lumen and is usually seen during blood stasis in dysfunctional left atrium. However, SEC and consecutive local thrombus formation at the carotid artery early after carotid endarterectomy (CEA) have not been reported. This study retrospectively investigated the clinical importance and therapeutic strategy of postoperative SEC and thrombus formation in 113 consecutive patients who underwent CEA between 2001 and 2009. Ultrasonography was routinely performed preoperatively, intraoperatively, and 1 day and 1 week after the operation. If SEC and/or thrombus was detected at any time after the operation, follow-up ultrasonography was performed at short intervals, once a week for inpatients and once every 1-2 months for outpatients. Eight of the 113 patients (7%) had SEC after the operation from Day 1 to 12 (mean 7.2 days), and 6 of these 8 patients developed local de novo thrombus formation at the site of SEC from Day 6 to 33 (mean 14.7 days). The maximum luminal narrowing by the thrombi were 26-62% (mean 37%). After administering anticoagulant therapy, all thrombi disappeared from Day 13 to 190 (mean 57 days) from CEA. SEC seen after CEA is highly associated with consecutive local thrombus formation. Postoperative geometric blood stasis with the absence of intima may be the causative factor for its development.
authors.affiliation: Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido. masahitokawabori@yahoo.co.jp
authors.forename: Masahito
authors.initials: M
authors.lastname: Kawabori
authors.forename: Tetsuyuki
authors.initials: T
authors.lastname: Yoshimoto
authors.forename: Masaki
authors.initials: M
authors.lastname: Ito
authors.forename: Shin
authors.initials: S
authors.lastname: Fujimoto
authors.forename: Taisei
authors.initials: T
authors.lastname: Mikami
authors.forename: Mutsuko
authors.initials: M
authors.lastname: Muraki
authors.forename: Sadao
authors.initials: S
authors.lastname: Kaneko
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kuroda
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Houkin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D001783:Blood Flow Velocity / Q000502:physiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D002341:Carotid Artery Thrombosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color
chemical_list: D000925:Anticoagulants