Abstract
Completion angioscopy was performed in 325 patients after carotid endarterectomy for carotid artery stenosis. Indications for operation included asymptomatic stenosis (39%), transient ischemic attack (35%), stroke (24%), and recurrent stenosis (2%). Endarterectomy closure included primary (94) and patch angioplasty utilizing vein, (106), polytetrafluoroethylene (117), and Hemashieldg (8). A fiberoptic angioscope was inserted at the end of the carotid endarterectomy through the remaining opening in the suture line. Sixteen abnormalities were appreciated with angioscopy, which included (1) 6 intimal flaps, (2) 8 thrombi, (3) 1 stenosis, and (4) 1 fibrous debris. Interventions with these abnormalities included (1) revision of all intimal flaps and 5 thrombi, (2) manual extraction of 2 thrombi, (3) irrigation of a thrombus and of the fibrous debris, and (4) excision of an adventitial band causing an internal carotid artery stenosis. Complications included transient ischemic attack (1%), stroke (2.5%), myocardial infarction (1%), nerve injury (6%), but no mortality. Patients with normal-appearing angioscopies had a stroke rate of 7/309 (2%) while those with abnormal-appearing angioscopies had a stroke rate of 1/16 (6%). The authors conclude that completion angioscopy can be safely and easily performed with a low perioperative stroke rate. Abnormalities detected may be corrected immediately. This method is recommended as a valuable adjunct to ensure technical success of carotid endarterectomy.
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