title: 64-detector CT angiography within 24 hours after carotid endarterectomy and correlation with postoperative stroke.
abstract: OBJECTIVE
  Carotid endarterectomy (CEA) carries a small but not insignificant risk of stroke/transient ischemic attack (TIA), most frequently observed within 24 hours of surgery, which can lead to the need for urgent vascular imaging in the immediate postoperative period. However, distinguishing expected versus pathological postoperative changes may not be straightforward on imaging studies of the carotid artery early after CEA. The authors aimed to describe routine versus pathological anatomical findings on CTA performed within 24 hours of CEA, and to evaluate associations between these CTA findings and postoperative stroke/TIA.
  
  
  METHODS
  The authors reviewed 113 consecutive adult patients who underwent postoperative CTA within 24 hours of CEA at a single academic institution. Presence and location of arterial "flaps," luminal "step-off," intraluminal thrombus and hematoma were documented from postoperative CTA scans. Medical records were reviewed to determine the incidence of new postoperative neurological findings.
  
  
  RESULTS
  Postoperative CTA findings included common carotid artery (CCA) step-off (63.7%), one or more intraarterial flaps (27.4%), hematoma at the surgical site (15.9%), and new intraluminal thrombus (7.1%). Flaps were seen in the external carotid artery (ECA), internal carotid artery (ICA), and CCA in 18.6%, 9.7%, and 6.2% of patients, respectively. New postoperative neurological findings were present in 7.1% of patients undergoing CTA. Flaps (especially ICA/CCA) and/or intraluminal thrombi were more frequently seen in patients undergoing CTA for new postoperative stroke/TIA (85.7%) versus patients undergoing CTA for routine postoperative imaging (14.3%, p = 0.002).
  
  
  CONCLUSIONS
  CTA within 24 hours of CEA demonstrates characteristic anatomical findings. CCA step-offs and ECA flaps are relatively common and clinically insignificant, whereas ICA/CCA flaps and thrombi are less frequently seen and are associated with postoperative stroke/TIA.
authors.affiliation: Departments of 1 Neurosurgery.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Gallati
authors.forename: Minal
authors.initials: M
authors.lastname: Jain
authors.forename: Dushyant
authors.initials: D
authors.lastname: Damania
authors.forename: Abhijit R
authors.initials: AR
authors.lastname: Kanthala
authors.forename: Anunaya R
authors.initials: AR
authors.lastname: Jain
authors.forename: George E
authors.initials: GE
authors.lastname: Koch
authors.forename: Nancy T M
authors.initials: NT
authors.lastname: Kung
authors.forename: Henry Z
authors.initials: HZ
authors.lastname: Wang
authors.forename: Robert E
authors.initials: RE
authors.lastname: Replogle
authors.forename: Babak S
authors.initials: BS
authors.lastname: Jahromi
mesh_terms: D000368:Aged; D016893:Carotid Stenosis / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography / Q000379:methods*; D015331:Cohort Studies; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D020767:Intracranial Thrombosis / Q000209:etiology; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D020521:Stroke / Q000175:diagnosis* / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: CCA = common carotid artery; CEA = carotid endarterectomy; CREST = Carotid Revascularization Endarterectomy versus Stenting Trial; CT angiography; CTA = CT angiography; ECA = external carotid artery; ICA = internal carotid artery; NASCET = North American Symptomatic Carotid Endarterectomy Trial; TIA = transient ischemic attack; carotid endarterectomy; stroke; vascular disorders