The significance of early postoperative duplex studies following carotid endarterectomy

This study was conducted to evaluate the significance of duplex ultrasound performed soon after carotid endarterectomy. The records of patients with 1 50 carotid endarterectomies and postoperative duplex ultrasound within 24 h were reviewed. Eleven (7.3%) had abnormal studies with greater than or equ al to 50% stenosis. Two patients with abnormal studies sustained a perioper ative stroke and three patients underwent reoperation for persistent lesion s (P < 0.001), Preoperative and postoperative cerebral imaging studies (com puted tomography (CT) or magnetic resonance imaging (MRI)) were performed o n 114 patients. Seven of these demonstrated areas of infarction and all sev en had abnormal duplex ultrasound studies. Twenty-six CT scans were perform ed with two positive for cerebral infarction in the two patients with clini cal stroke. In the 88 MRI studies, five demonstrated small, subcortical foc al areas of ischemia, which were clinically silent. The relationship of inf arction on postoperative cerebral studies and abnormal postoperative duplex ultrasound was significant (P < 0.0001), It was concluded that early posto perative duplex ultrasound studies of greater than or equal to 50% stenosis demonstrate significant association with postoperative stroke or reoperati on. as well as with ischemic changes on brain imaging studies. Earlier dete ction with intraoperative duplex would probably be more advantageous than p ostoperative duplex ultrasound. (C) 1999 The International Society for Card iovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.