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OBJECTIVES: Duplex ultrasonography following carotid endarterectomy (CEA) is the primary means of post-operative surveillance. Follow-up scans beyond the immediate post-operative period are intended to detect recurrent and contralateral disease. The optimal follow-up regimen utilizing duplex ultrasonography after CEA is not clearly defined. The purpose of this study was to determine the utility of 6-month duplex ultrasonography after CEA.
METHODS: Duplex ultrasound examinations of all patients who underwent CEA at our institution from 2005-2010 were reviewed. The immediate post-operative scan was defined as the initial scan performed within 3 months of surgery. The 6-month scan was defined as the second post-operative scan performed between 3 and 9 months after the operation. Ipsilateral and contralateral interventions were reviewed. Contralateral interventions occurring within 90 days of the initial operation and based on pre-operative duplex ultrasonography were considered planned.
RESULTS: 954 patients underwent CEA during the study period. 203 (21.3%) patients had immediate post-operative and 6-month ultrasounds. The majority (n=184, 90.6%) of patients had no significant disease (<50% stenosis) on their immediate post-operative study. Of these patients, 22 (12.0%) developed 50-69% stenosis, 2 (1.1%) progressed to 70-79% stenosis, and 0 to occlusion on their 6-month scan. For the patients with 70-79% stenosis, one had reintervention after the 1-year scan and another was lost to follow-up. One additional patient underwent reintervention for asymptomatic 50-69% stenosis at 6-months which progressed to 70-79% at 1-year. One patient (5.3%) in the immediate post-operative 50-69% stenosis group underwent reintervention at 140 days postoperatively for asymptomatic 50-69% stenosis due to mural thrombus previously seen on 1-month and 3-month scans.
CONCLUSIONS: For patients with <50% stenoses on immediate post-operative duplex ultrasonography following CEA, a 6-month duplex ultrasound scan does not appear to alter clinical decision making. Close surveillance for patients with >50% stenoses on immediate post-operative duplex ultrasonography is warranted.