RELATIONSHIP BETWEEN INTRAOPERATIVE COLOR-FLOW DUPLEX FINDINGS AND EARLY RESTENOSIS AFTER CAROTID ENDARTERECTOMY - A PRELIMINARY-REPORT

Purpose: This study was undertaken to examine the relationship between intraoperative color-flow duplex (CFD) findings and the development o f restenosis in patients undergoing carotid endarterectomy (CEA). Meth ods: Seventy-eight patients (43 male and 35 female; mean age, 65 years ) underwent 86 CEAs (eight staged bilateral) and intraoperative CFD du ring a 31-month period, Three patients (three CEAs, 3%) underwent both CFD and a completion arteriographic scan. Patients were observed in a postoperative protocol using CFD surveillance. The fellow-up interval ranged from 6 to 24 months (average, 12 months). Results: After under going CEA, 10 patients (10 CEAs, 11%) had an abnormality detected by i ntraoperative CFD; one was confirmed with a completion arteriographic scan. These abnormalities consisted of elevated peak systolic velociti es (Pm) with a mosaic color pattern suggesting turbulence seen in six CF;As, including one internal carotid artery (ICA) with abnormal hemod ynamics and an unremarkable completion arteriogram. Intimal defects on B-mode were seen in another four CEAs. These carotid arteries were re explored, defects (intimal flaps with platelet thrombus) were confirme d by direct examination, and all were repaired with or without a patch (six ICAs, three external carotid arteries, and one common carotid ar tery). No cerebrovascular events occurred in the perioperative period. No carotid restenosis (greater than or equal to 50% diameter reductio n) was identified during follow-up of 43 patients (48 CEAs, 56%). Two patients had recurrent neurologic symptoms. Conclusion: Intraoperative CFD is an effective test for detecting flow abnormalities or intimal defects in patients undergoing CEA. Ensuring normal intraoperative hem odynamics after CEA may be a major factor associated with decreased in cidence of perioperative cerebrovascular events and subsequent carotid artery restenosis.