Key result
Intraoperative ultrasonography during carotid endarterectomy detects technical defects requiring surgical repair in ~13% of cases.
Why the study?
Anatomical information about the arterial wall during carotid endarterectomy is poorly monitored intraoperatively despite the risk of postoperative ischemic complications and restenosis from technical defects.
Does intraoperative ultrasonography improve the detection of technical defects and evaluation of vascular wall and hemodynamics during carotid endarterectomy?
Observational (n=24)
No
Does intraoperative ultrasonography improve the detection of technical defects and evaluation of vascular wall and hemodynamics during carotid endarterectomy?
Intraoperative ultrasonography during carotid endarterectomy provides real-time evaluation of the vascular wall and hemodynamics, enabling the immediate detection and repair of technical defects.
May facilitate immediate defect repair during carotid endarterectomy; hypothesis-generating and should not yet change practice.
Various kinds of intraoperative monitoring are used in carotid endarterectomy (CEA) such as somatosensory encephalogram or transcranial Doppler for detection of cerebral ischemia or microembolism. However, anatomical information about arterial wall, which is manipulated directly, is poorly monitored during operation. Postoperative ischemic complication and restenosis can be occasionally caused by failure of manipulation of intimal stump during CEA. Technical defects can be repaired if intramural problems are detected by ultrasonography (USG) during operation. In 24 cases of CEA between October 2001 and March 2004, we performed intraoperative USG to monitor the arterial wall and hemodynamics. Intraoperative digital angiography (DSA) was performed to compare USG findings. We were able to grasp characteristics and extension of plaque before arteriotomy. It was especially useful for the cases whose plaque end was obscure by DSA. An intimal stump on both sides after CEA could be recognized by B-mode scans. Peak systolic velocities measured by the pulse Doppler method were decreased in all cases after CEA. Three cases were repaired following recognition of technical defects by USG. One was an intimal flap over 2 mm; the others were due to residual common carotid artery lesion. In conclusion, intraoperative USG in CEA was useful in terms of grasping both information of vascular wall and intraluminal hemodynamics in real time, and allowed the detection of technical defects that required surgical repair. Intraoperative USG monitoring may improve operative results by reducing technical defects.
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Matsumoto et al. (2004) conducted an observational in Carotid artery stenosis (n=24). Intraoperative ultrasonography was evaluated on Detection of technical defects requiring surgical repair. Intraoperative ultrasonography during carotid endarterectomy allowed real-time evaluation of vascular wall and hemodynamics, detecting technical defects that required surgical repair in 3 of 24 cases.
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