INTRAOPERATIVE DUPLEX SCANNING REDUCES THE INCIDENCE OF RESIDUAL STENOSIS AFTER CAROTID ENDARTERECTOMY

We studied the effect of intraoperative duplex scanning on the inciden ce of residual and recurrent stenosis and stroke after carotid endarte rectomy (CEA), We retrospectively analyzed 98 veteran patients undergo ing 106 consecutive CEAs between July 1990 and June 1994, Follow-up du plex scans were available for 86 cases (81%, mean follow-up 20 months) . There were no perioperative deaths, Intraoperative duplex scans were obtained in 39 (45%) of 86 CEAs, The incidence of residual stenosis w as lower in the patients scanned at the time of surgery (0 of 39) than in those who underwent CEA without intraoperative scan (7 of 47, P < 0.04). One patient who did not receive intraoperative duplex scanning underwent redo CEA for symptomatic residual stenosis due to an intimal flap of the carotid artery. Operative management was changed in 9 of 39 cases because of abnormal intraoperative duplex scans, with no post operative strokes or residual/recurrent stenosis, The incidence of rec urrent stenosis was not different in the two groups (2 of 39 vs 2 of 4 7, ns). There was no difference in stroke rate. There were three strok es, one perioperative and two postoperative (mean 3.5 months, range 0. 5 to 9), Two of the three patients did not undergo an intraoperative d uplex scan, but none had developed restenosis >50% over a mean of 21 m onths of follow-up, Intraoperative duplex scanning significantly reduc ed the incidence of residual stenosis, but did not affect the incidenc e of recurrent stenosis or stroke following CEA. (C) 1996 Academic Pre ss, Inc.