Prevalence and clinical consequences of carotid artery residual defects following endarterectomy: a prospective CT angiography evaluation study

Eur J Vasc Endovasc Surg. 2011 Aug;42(2):144-52. doi: 10.1016/j.ejvs.2011.03.015. Epub 2011 Apr 30.


Objectives: It is still unclear whether residual defects seen after carotid endarterectomy (CEA) have clinical consequences. We investigated prevalence of residual defects in the carotid artery and their possible impact on clinical and Duplex ultrasound (DUS) follow-up.

Materials and methods: Sixty-five patients who had undergone CEA were prospectively examined with 1-3 month postoperative computed tomographic angiography (CTA), clinical and DUS follow-up. Defects in common (CCA), external (ECA) and internal carotid artery (ICA) were scored as clamp marks, intimal step or flap, mural thrombus, kink, microdehiscence suture or residual stenosis.

Results: Fifty-eight patients (89.2%) had residual defects in CCA, ECA or ICA (143 defects). Intimal steps (n = 39) and residual stenosis (n = 17) were most noted defects. Only residual defects in ECA were significantly associated with significant higher PSV values both at short-term and long-term follow-up (1990 vs. 1400 mm s(-1) at 1 year and 2000 vs. 1230 mm s(-1) at 2 years, P-values 0.031 and 0.016).

Conclusion: Carotid artery residual defects on CTA after CEA are very common, simple fingerprints of the operative procedure, have no clear consequence. When CTA is performed clinically after CEA, knowledge of high prevalence and type of defects detected on CTA may be of importance for radiologists and clinicians.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Carotid Stenosis / diagnostic imaging*
  • Carotid Stenosis / epidemiology
  • Carotid Stenosis / surgery*
  • Chi-Square Distribution
  • Endarterectomy, Carotid* / adverse effects
  • Female
  • Humans
  • Ischemic Attack, Transient / diagnostic imaging
  • Ischemic Attack, Transient / etiology
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Predictive Value of Tests
  • Prevalence
  • Prospective Studies
  • Recurrence
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Stroke / diagnostic imaging
  • Stroke / etiology
  • Time Factors
  • Tomography, X-Ray Computed*
  • Treatment Outcome
  • Ultrasonography, Doppler, Duplex