Carotid Endarterectomy: Emphasis on Necessity of Long-Term Postoperative Evaluation

Abstract

Carotid endarterectomy remains an effec tive means of preventing a stroke in patients with extracranial carotid lesions. Although long-term patency may be assumed, the true incidence of recurrent pathology is not known. In the past, follow-up angiography has been performed only when recommended for recurrent symptoms and some postoper ative bruits. Four different pathologic condi tions found at the endarterectomized bifur cation site are discussed as are their treat ments.

Long-term follow-up evaluation is strongly recommended. Angiography is in dicated for recurrent symptoms. Carotid bruits are difficult to evaluate on a yearly basis. Vascular laboratory studies are recom mended 4 months after surgery and then on a yearly basis. Hopefully, early and late res tenosis will be identified. An artery should be explored when symptoms and angiog raphic findings indicate recurrent pathology.