Purpose: The purpose of this study was to assess the effect of intraop
erative duplex scanning on early and late results after carotid endart
erectomy. Methods: We reviewed 316 carotid arteries in 283 patients wh
o underwent operation Since 1986. The results of intraoperative ultras
onography were normal in 254 (80.4%) and abnormal in 62 (19.6%). We di
d not reexplore 53 (85.5%) of the abnormalities because the defect was
minor, 2 to 3 mm or less. These defects were retained atheroma in the
common carotid artery (n = 35), internal carotid artery (ICA) (n = 5)
, external carotid artery (n = 2), small frond in the bulb (n = 2), th
ickened wall of the vein patch (n = 2), and ICA kink (n = 7), two of w
hich were associated with retained atheroma. Nine defects (14.5%) were
reexplored and repaired; there were seven flaps, one residual plaque,
and one case with turbulent flow alone. Results: Patients with a norm
al examination result had an early ICA occlusion rate of 0.79% (n = 2)
, an early stroke rate of 1.6% (n = 4), and one death (0.4%). In the u
nrepaired group these rates were 1.9% (n = 1) and 1.9% (n = 1), respec
tively. No occlusion occurred in the repaired group, but one preexisti
ng cerebrovascular accident worsened immediately after operation. freq
uency analysis and B-mode imaging were performed after operation and e
very 6 to 12 months in all patients (mean 21.6 months). A greater than
75% area stenosis was found in nine (17%) of the 53 unrepaired caroti
d arteries, but in only four (4.3%) of the 254 carotid arteries lackin
g defects and in one of the reopened group (p < 0.001). There have bee
n no late strokes, and only three late transient ischemic attacks over
all. Conclusions: A normal intraoperative scanning result obtained aft
er carotid endarterectomy is associated with improved late patency rat
es. Even small defects appear to be associated with an increased incid
ence of late restenosis, reemphasizing the importance of technical per
fection.