Intraoperative and early postoperative colour Doppler sonography after carotid artery reconstruction: follow-up of technical defects

Dorffner, Roland; Metz, V.; Trattnig, Siegfried; Eibenberger, K.; Dock, W; Hörmann, Marcus; Trubel, W.; F, Grabenwöger

doi:10.1007/s002340050377

Cited by 10 publications

(6 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Completion angiography, intraoperative duplex scanning and angioscopy have been used individually or in combination to assess the technical success of CE, although duplex scanning seems to play a greater role nowadays due to its overall feasibility and efficacy (11). It has been suggested that abnormalities left uncorrected at the time of CE may contribute to restenosis, although small intimal flaps probably do not matter (24). Other residual lesions that may be present post‐CE include atheroma, intraluminal thrombi, kinks and vein patch irregularities.…”

Section: Aetiology and Pathophysiologymentioning

confidence: 99%

Restenosis after carotid endarterectomy

Sadideen¹,

Taylor

Padayachee³

2006

International Journal of Clinical Practice

View full text Add to dashboard Cite

Multiple randomised trials over the last decade for both symptomatic and asymptomatic carotid stenosis have proven the efficacy of carotid endarterectomy (CE) in reducing the risk of stroke. The long-term patency of the carotid artery after CE is an important factor in the success of the operation. The incidence of recurrent carotid stenosis (excluding residual lesions) ranges from 1 to 37% with only 0-8% of patients having restenosis-related symptoms (1). Generally, recurrent carotid stenosis is attributed to myointimal hyperplasia during the early postoperative period (within 3 years) or recurrent atherosclerosis thereafter. The management of recurrent carotid stenosis after CE remains a dilemma. It is generally accepted that operation for significant recurrent carotid stenosis is indicated for symptomatic patients, and several authors also recommend CE for >80% asymptomatic recurrent stenosis. Treatment of recurrent carotid stenosis involves repeat endarterectomy with patch angioplasty, although more recently endovascular techniques have been used.

show abstract

Section: Aetiology and Pathophysiologymentioning

confidence: 99%

Restenosis after carotid endarterectomy

Sadideen¹,

Taylor

Padayachee³

2006

International Journal of Clinical Practice

View full text Add to dashboard Cite

show abstract

“…Ultimately, 9 studies were eligible and included in the quantitative analysis. [6][7][8][9][21][22][23][24][25] The summarizing PRISMA flow chart is outlined in Fig. 4.…”

Section: Systematic Literature Reviewmentioning

confidence: 99%

Management of postoperative internal carotid artery intimal flap after carotid endarterectomy: a cohort study and systematic review

Rychen

Madarasz²,

Murek³

et al. 2022

Journal of Neurosurgery

View full text Add to dashboard Cite

OBJECTIVE Postoperative internal carotid artery (ICA) intimal flap (IF) is a potential complication after carotid endarterectomy (CEA) for carotid artery stenosis. There are no clear recommendations in the current literature on the management of this condition due to sparse evidence. Some authors advocate carotid stent placement or reoperation, while others suggest watchful waiting. The aim of this study was to analyze incidence and management strategies of postoperative ICA-IF, and moreover, to put these findings into context with a systematic literature review. METHODS The authors retrospectively reviewed all consecutive CEA cases performed at the University Hospital of Bern over a decade (January 2008 to December 2018). The incidence of postoperative ICA-IF, risk factors, management strategies, and outcomes were analyzed. These results were put into context with a systematic review following the PRISMA guidelines. RESULTS A total of 725 CEAs were performed between January 2008 and December 2018. Postoperative ICA-IF was detected by routine duplex neurovascular ultrasound (NVUS) in 13 patients, corresponding to an incidence rate of 1.8% (95% CI 1.0%–3.1%). There were no associated intraluminal thrombi on the detected IF. Intraoperative shunt placement was used in 5.6% and one or more intima tack sutures were performed in 42.5% of the 725 cases. There was no significant association between intraoperative shunt placement and the occurrence of an IF (p > 0.99). Two patients (15.4%) with IF experienced a transient postoperative neurological deficit (transient ischemic attack). In these cases, the symptoms resolved spontaneously without any interventions or change in the antiplatelet regimen. All other cases (84.6%) with IF were asymptomatic. In 1 patient (7.7%) with IF, the antiplatelet treatment was switched from a mono- to a dual-antiaggregating regimen because the IF led to a stenosis > 70%; this patient remained asymptomatic. All cases of IFs were managed conservatively with close radiological follow-up evaluations, without reoperation or stenting of the ICA. All 13 IFs vanished spontaneously after a mean duration of 6.9 months (median 1.5 months, range 0.5–48 months). A systematic literature review revealed a postoperative ICA-IF incidence of 3.0% (95% CI 2.1%–4.1%) with relatively heterogenous management strategies. CONCLUSIONS Postoperative ICA-IF is a rare finding after CEA. Conservative therapy with close NVUS follow-up evaluations appears to be an acceptable and safe management strategy for asymptomatic IFs without associated intraluminal thrombi.

show abstract

“…Auch bei diesen Rekonstruktionen finden sich in ca. 10-30% morphologische Läsionen oder hämodynamische Störungen (Turbulenzen), die hypothetisch einen Insult verursachen oder mit verursachen können [4,11,22,38]. Rekonstruktionen, die für die Peripherie akzeptiert werden können, erzeugen an der zerebralen Strombahn u. U. neurologische Ereignisse und sind daher nicht zu tolerieren.…”

Section: Irregularitäten Der Rekonstruktionunclassified

“…In der Literatur werden residuelle Läsi-onen oder hämodynamische Probleme in 2-30% angeschuldigt, die in 2-12% zu einer sofortigen Reinterventionen führten, wenn ein intraoperatives Qualitätsmoni-toring während der Karotisrekonstruktion vorgenommen wurde [2,4,11,14,15,18,20,22,27,28,32,38].…”

Section: > Erfahrung Und Fallzahl Nehmen Einfluss Auf Das Ergebnis Deunclassified