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Abstract

Carotid ultrasound plays a primary role following carotid endarterectomy in the detection of postsurgical complications. Gray-scale, real-time imaging detects and quantifies tissue inter-faces and plaque morphology. Doppler spectral analysis provides quantitative and graphic dis-play of blood flow velocity and direction. Color flow imaging identifies areas of disturbed flow and can aid in detecting surface irregularities by the flow disturbances they create. Power Doppler is useful in detecting slow blood flow and characterizing plaque surface. During a carotid endarterectomy, the diseased intima and part of the diseased media are removed. Postoperative complications fall into the 3 following categories and vary with the postoperative time interval. Technical errors occurring within the first month are most often related to surgical problems, such as residual plaque, arterial clamp injury, or an intimal flap. Restenosis postoperatively within the first 3 years results from neointimal hyperplasia, which involves the smooth muscle and fibrous overgrowth of the tissue layer that replaces the intima after surgery. After 3 years, the material causing restenosis is more apt to resemble atherosclerotic plaque with abundant collagen, foam cells, and calcium deposits, and is commonly associated with the development of recurrent atherosclerosis.

Keywords

carotid ultrasound carotid endarterectomy residual plaque neointimal hyperplasia restenosis

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Duplex Evaluation of the Postoperative Carotid

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