Abstract
Ulcerated or irregular heterogeneous carotid plaque as seen by duplex ultrasound can cause hemispheric transient ischemic attacks (TIAs) and/or a cerebrovascular accident, even if only associated with nonsignificant carotid stenosis on arteriography. The purpose of this study was to review our experience in patients who underwent a carotid endarterectomy after medical treatment had failed, based on pathologic findings detected by carotid duplex ultrasound with minimal disease on arteriography. The medical records of 14 patients who underwent cartoid endarterectomy for TIA symptoms related to ulcerated or irregular heterogeneous plaques were analyzed. All had had preoperative carotid duplex ultrasound, arteriography, and cardiac and neurologic workups to rule out other causes for their TIAs. Medical treatment had failed in all of them. There were 10 men and four women whose median age was 68 years. Carotid duplex ultrasound showed irregular heterogeneous carotid plaque in all patients associated with 20% to 50% stenosis in 12 and approximately 50% to 60% stenosis in two. All had normal to <20% stenosis on arteriograms. The duplex ultrasound findings were all confirmed at operation. All had an uneventful postoperative course with relief of symptoms. Carotid duplex ultrasound is superior to carotid arteriography in detecting irregular or ulcerative heterogeneous plaque associated with nonsignificant stenosis. Carotid duplex ultrasound can be used to determine the desirability of carotid endarterectomy after failed medical treatment in patients with classical and persistent TIA symptoms despite normal or minimal disease on arteriograms. A successful endarterectomy appears to predict an asymptomatic postoperative course.
Similar content being viewed by others
References
Moore WS, Hall AD. Importance of emboli from carotid bifurcation in pathogenesis of cerebral ischemic attacks. Arch Surg 1970;101:708–716.
Moore WS, Clark B, Malone J, et al. Natural history of nonstenotic asymptomatic ulcerative lesions of the carotid artery. Arch Surg 1978;113:1356–1359.
Wagner WH, Treiman RL, Cossman DV, et al. The diminishing role of diagnostic arteriography in carotid artery disease: Duplex scanning as definitive preoperative study. Ann Vasc Surg 1991;5:105–110.
Robin JR, Bondi JA, Rhodes RS. Duplex scanning versus conventional arteriography for the evaluation of carotid artery plaque morphology. Surgery 1987;102:749–755.
Senkowsky J, Bell WH III, Kerstein MD. Normal angiograms and carotid pathology. Am Surg 1990;56:726–729.
Thiele BL, Young JV, Chikos PM, et al. Correlation of arteriographic finding and symptoms in cerebrovascular disease. Neurology 1980;30:1041–1046.
O'Donnell TF, Pauker SG, Callow AD, et al. The relative value of carotid noninvasive testing as determined by receiver operator characteristic curves. Surgery 1980;87:9–19.
AbuRahma AF, Boland JP, Robinson P, et al. Antiplatelet therapy and carotid plaque hemorrhage and its clinical implications. J Cardiovasc Surg 1990;31:66–70.
Lusby RJ, Ferrel LD, Ehrenfeld WK, et al. Carotid plaque hemorrhage: Its role in production of cerebral ischemia. Arch Surg 1982;117:1479–1488.
Rothwell PM, Gibson RJ, Slattery J, et al. Equivalence of measurements of carotid stenosis: A comparison of three methods on 1001 angiograms. Stroke 1994;25:2435–2439.
Rothwell PM, Gibson RJ, Slattery J, et al. Prognostic value and reproducibility of measurements of carotid stenosis: A comparison of three methods on 1001 angiograms. Stroke 1994;25:2440–2444.
Horn M, Michelini M, Greisler HP, et al. Carotid endarterectomy without arteriography: The preeminent role of the vascular laboratory. Ann Vasc Surg 1994;8:221–224.
Chervu A, Moore WS. Carotid endarterectomy without arteriography. Ann Vasc Surg 1994;8:296–302.
Croft FJ, Ellam LD, Harrison MJG. Accuracy of carotid angiography in the assessment of atheroma of the intimal carotid artery. Lancet 1980;1:997–1000.
Eihelboum BC, Riles TR, Mintzer N, et al. Inaccuracy of angiography in the diagnosis of carotid ulceration. Stroke 1983;14:882–885.
Johnson JM. Angiography and ultrasound in diagnosis of carotid artery disease: A comparison. Contemp Surg 1982;20:79–93.
O'Donnell TF, Erdoes L, Mackey WC, et al. Correlation of B-mode ultrasound imaging and arteriography with pathologic findings at carotid endarterectomy. Arch Surg 1985;120:443–449.
Johnson JM, Kennely M, O'Holleran L, et al. A comparison angiography ultrasound in the diagnosis of carotid artery disease. Contemp Surg 1985;26:31–86.
Blackshear WM, Connar RG. Carotid endarterectomy without angiography. J Cardiovasc Surg 1982;23:477–482.
Akers DL, Bell WH III, Kerstein MD. Does intracranial dye study contribute to evaluation of carotid artery disease? Am J Surg 1988;156:87–90.
North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–453.
European Carotid Surgery Trialists' Collaborative Group. MRC European Carotid Surgery Trial. Interim results for symptomatic patients with severe (70–99%) or with mild (0–29%) carotid stenosis. Lancet 1991;337:1235–1243.
Author information
Authors and Affiliations
About this article
Cite this article
AbuRahma, A.F., White, J.F. & Boland, J.P. Carotid endarterectomy for symptomatic carotid artery disease demonstrated by duplex ultrasound with minimal arteriographic findings. Annals of Vascular Surgery 10, 385–389 (1996). https://doi.org/10.1007/BF02286785
Issue Date:
DOI: https://doi.org/10.1007/BF02286785