Will carotid thromboendarterectomy remain competitive? Influence of intraoperative duplex ultrasound quality control

Background. Thromboendarterectomy (TEA) and stenting are in competition for treatment of carotid artery lesions. Both treatment modalities have to improve significantly. The goal of the study was to evaluate the influence of routine intraoperative duplex ultrasound examination. Methods. In a continuous prospective study, 575 patients underwent 620 carotid operations. Intraoperative duplex ultrasound examination was performed prior to wound closure: 9.5\% had significant contralateral ICA stenoses and 6.7\% ICA occlusion; 8.5\% presented special lesions. An eversion TEA was performed in 20.5\% while 78.5\% underwent conventional TEA with patch plastyand graft interposition in 1\%, Intraoperative quality control revealed unexpected lesions in 10\% requiring immediate repair: Results. The combined morbidity/mortality rate (MMR) of the total series was 2.6\%. Women had an elevated risk (4.2\%) in comparison to men (1.9\%): The risk of elder patients (>75 years, n=151) was remarkably Iow. The neurological complication rate of the total series was 1.6\% and the incidence of major strokes 1.1\%. Conclusions. Routine intraoperative duplex ultrasound examination of the carotid reconstruction allows early diagnosis and immediate correction of morphologic as well as hemodynamic lesions. Competing with stent placement a further reduction of complications of carotid TEA seems to be possible and necessary.