DUPLEX IMAGING FINDINGS PREDICT STENOSIS AFTER CAROTID ENDARTERECTOMY

Purpose: This study was performed to determine whether early duplex fi ndings predicted restenosis after carotid endarterectomy. Methods: One hundred,ninety-two symptomatic patients who underwent carotid endarte rectomy were studied with color duplex imaging at 1 day and 1 week aft er surgery to identify minor residual disease (causing <50% stenosis), arterial kinking, and suture stricture, and to measure the external a nd luminal diameters of the carotid bulb and distal internal carotid a rtery. Patients were then observed prospectively with duplex surveilla nce for a median of 24 months to identify > 50% restenosis. Results: T wenty-five stenoses > 50% of the operated carotid artery (13%) were id entified, four at 1 day (residual) and 21 at a median follow-up of 6 m onths (restenosis). On multiple logistic regression analysis, >50% res tenosis was found to be associated with minor day-1 residual stenosis (p = 0.01) and with small luminal diameter of the distal internal caro tid artery (p = 0.03) as measured 1 week after carotid endarterectomy. Life table analysis showed restenosis at 24 months to be more common for patients with below-median than patients with above-median carotid bulb external diameter (18% vs 5%, respectively; P = 0.01). Conclusio ns: Duplex scanning within a week of carotid endarterectomy identifies >50% residual stenosis, in addition to minor residual 25% to 50% sten osis and small carotid dimensions, which are good predictors of >50% r estenosis at 6 months.