CLINICAL FOLLOW-UP RATHER THAN DUPLEX SURVEILLANCE AFTER CAROTID ENDARTERECTOMY

Purpose: The value of duplex surveillance and the significance of cont ralateral carotid disease after endarterectomy have been assessed. Met hods: Three hundred five patients were observed prospectively after ca rotid endarterectomy for a median time of 36 months (range, 6 to 96 mo nths), with duplex surveillance performed at 1 day; 1 week; 3, 6, 9, a nd 12 months; and then each year after endarterectomy. Results: Thirty patients (10%) had ipsilateral symptoms (13 strokes, 17 transient isc hemic attacks [TIAs]) at a median time of 6 months (range, 0 to 60 mon ths). Life table analysis demonstrated that ipsilateral stroke was equ ally common for patients who had greater than or equal to 50% restenos is (3% at 36 months) and those who did not (6% at 36 months, p >0.5). Twenty-three patients (8%) developed symptoms (stroke 5, TIA 14) attri butable to the contralateral carotid artery at a median time of 9 mont hs (range, 0 to 36 months) after endarterectomy. By life table analysi s, 40% of patients with 70% to 99%, 6% with 50% to 69%, 1% with <50% c ontralateral internal carotid stenosis, and 5% with contralateral caro tid occlusion at the time of endarterectomy had a contralateral TIA in the 36 months after endarterectomy (p <0.01). However, contralateral stroke was not significantly more common for patients with severe cont ralateral internal carotid stenosis demonstrated at the time of endart erectomy (<50% stenosis, 0%; 50% to 69%, 3%; 70% to 99%, 7%; occlusion , 6% stroke rate at 36 months). Seven of the 32 patients who developed progression of contralateral disease had a TIA, compared with 11 of 2 27 patients who did not develop progression of contralateral disease ( p <0.01). None of the 12 patients who progressed from a <70% to a 70% to 99% contralateral stenosis had a stroke. Conclusions: After carotid endarterectomy restenosis is rarely associated with symptoms; contral ateral stroke is rare and is not associated with progressive internal carotid artery disease suitable for endarterectomy. This study has sho wn no benefit from long-term duplex surveillance after carotid endarte rectomy. Selective clinical follow-up of patients who have high-grade contralateral stenoses would appear more appropriate.