EARLY PATENCY OF THE CAROTID-ARTERY AFTER ENDARTERECTOMY - DIGITAL SUBTRACTION ANGIOGRAPHY AFTER 262 OPERATIONS

Abstract

During a 12-mo. period of study, 265 patients (mean age 65 yr) underwent a total of 314 carotid endarterectomies for the management of previous transient cerebral ischemia (39%), prior stroke (10%) or severe asymptomatic carotid stenosis (51%). Five patients (1.6%) died within 30 days of operation, but only 3 deaths (1%) were related to carotid reconstruction. Six patients (1.9%) experienced postoperative strokes, including 1.6% of those with previous transient ischemia, 9.7% of those with prior strokes (P < 0.02), and 0.6% of those with asymptomatic carotid stenosis before operation. Digital subtraction angiography (DSA) was performed during the same hospital admission following 262 procedures in a group of 214 patients, including all ptients who had postoperative neurologic complications. Seven of these operations were limited to external carotid endarterectomy. The internal carotid artery was entirely normal in 239 (94%) of the remaining 255 DSA studies. The external carotid artery was normal on 238 (93%) of 255 DSA examinations, but was occluded on 12 (4.7%). A focal intimal defect corresponding to the apical arteriotomy suture was found in 9 internal carotid arteries (3.6%), but these lesions did not appear to be hemodynamically significant. The internal carotid artery contained over 30% stenosis in 2 patients (0.8%) and was occluded in 5 (1.9%). Two of these 5 patients had neurologic complications, but 4 others with operative strokes had normal angiograms. Asymptomatic postoperative thrombosis of the internal carotid artery was documented in only 3 patients (1.3%).