ONE-YEAR OF PROSPECTIVE FOLLOW-UP AFTER CAROTID THROMBENDARTERECTOMY - A CLINICAL AND DUPLEX STUDY

Objectives - The aim of this study was to make a prospective evaluatio n of the carotid arteries after thrombendarterectomy by combined clini cal and duplex examination, to define an exact time of development of postoperative restenosis/occlusion and to relate early morphological c hanges to occurrences of new neurological events. Material and methods - Sixty-four patients (66 operations), 48 men and 16 women, mean age of 63+/-8 (SD) years, with transient ischaemic attacks or minor stroke were examined clinically 1 day before and after the carotid surgery. All except 3 patients had stenosis greater than or equal to 50%. Duple x scanning and periorbital Doppler were performed before aortic arch a ngiography, within 2 weeks after operation and thereafter at 3, 6 and 12 months. Results - 10 patients experienced minor stroke and one majo r stroke after operation, in 5 patients connected with occlusion on th e operated side, which differed (P<0.01) from 56 patients with open ve ssels in whom 6 ipsilateral minor strokes occurred. Four of 6 patients with minor stroke, in whom the operated vessels were open, recovered, whereas the neurological deficits were permanent in all 5 patients wi th occlusion (P<0.05). Duplex scanning confirmed 10 new occlusions and 2 high grade stenoses >75% postoperatively. Persisting morbidity was 11% and no mortality at 3 months' control. At 12 months' control, 1 pa tient had stroke related to preoperatively diagnosed occlusion on the non-operated side and 14 flow reducing lesions >75% (11 occlusions and 3 stenoses >75%) were found in 57 (24.6%) of examined vessels. Conclu sion - occlusion occurs in immediate postoperative period and seems to be a serious complication connected with significantly higher number of persistent neurological events than open vessels.