title: Resolution of carotid stenosis pre-carotid intervention: A case for selective preoperative duplex ultrasound.
abstract: BACKGROUND
  Spontaneous resolution of carotid stenosis is a phenomenon that has been described in literature in the past. At present it is not routine practise to scan patients prior to carotid endarterectomy surgery within the UK.
  
  
  METHODS
  A 58 year old female presented to hospital with a history of sudden onset headache and left sided weakness. CT head showed findings in keeping with an acute right MCA territory infarct. A duplex ultrasound scan showed echolucent material in the right internal carotid artery forming a greater than 95% stenosis. The scan was unable to visualise the patency of the vessel distally due to the position of the mandible. The patient was provisionally listed for carotid endarterectomy. An MRA was requested prior to surgery to assess the patency of the distal internal carotid artery. The MRA of the carotids showed normal appearance of the common carotid, internal and vertebral arteries with no definite stenosis. A repeat duplex ultrasound confirmed there was no significant stenosis.
  
  
  CONCLUSIONS
  The finding of complete resolution of stenosis on MRA was an unexpected event. Had the initial duplex imaging allowed visualisation of the distal vessel patency, our patient would have undergone unnecessary carotid surgery with the associated morbidity and mortality.
  
  
  CONCLUSIONS
  This case report draws attention to the benefits of selective preoperative scanning, in sparing patients from unnecessary surgery as a result of finding occlusion or resolution of a previously diagnosed carotid stenosis.
authors.affiliation: Department of Vascular Surgery, Blackpool Victoria Hospital, Lancashire, fy3 8nr, United Kingdom. Electronic address: abidali786@doctors.org.uk.
authors.forename: Abid
authors.initials: A
authors.lastname: Ali
authors.affiliation: Department of Vascular Surgery, Blackpool Victoria Hospital, Lancashire, fy3 8nr, United Kingdom. Electronic address: mohammedashrafi@doctors.org.uk.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ashrafi
authors.affiliation: Department of Vascular Surgery, Blackpool Victoria Hospital, Lancashire, fy3 8nr, United Kingdom. Electronic address: iraj.zeynali@bfwhospitals.nhs.uk.
authors.forename: Iraj
authors.initials: I
authors.lastname: Zeynali
keywords: Carotid stenosis; Preoperative duplex ultrasound; Spontaneous resolution