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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 1999 February;40(1):27-9

VASCULAR PAPERS 

 ORIGINAL ARTICLES

Con­trol of the oper­ated ­carotid ­with ultra­sound. Ana­tom­ical and hemo­dy­nam­ical mod­ifi­ca­tions, ­both ­local and intra­cra­nial

Berni A., Cavaiola S. *, Carra A., Fiorellino A., Tombesi T., Tromba L.

From the ­Chair of Clin­ical Meth­o­dology Uni­ver­sity of ­Rome “La ­Sapienza”
* Istituto Tecnologie Biomediche, CNR, Rome, Italy

Back­ground. A ­study has ­been ­done on the oper­ated ­carotid mon­i­toring the mod­ifi­ca­tions of the ­wall and of the ­flow in the ­site of the oper­a­tion and at the intra­cra­nial ­level.
­Methods. 146 oper­ated ­carotids ­were ­studied ­using trans­cra­nial Dop­pler, ­duplex and ­color. The pre-sur­gical ­data ­were con­fronted ­with the ­postsur­gical ­ones on the 4th day, one ­month ­later, 3 ­months ­later and ­every 6 ­months.
­Results. The cereb­ro­vas­cular reac­tivity (CR) and the cere­bral hemo­dy­namic ­latency ­time (­CHLT), ­improved in ­more ­than ­half of the ­patients ­with sten­osis >80%. ­When the sten­osis is of ­minor ­entity, the improve­ment ­appears in 10% of the ­cases. The VCR and ­CHLT mod­ifi­ca­tions ­appear ­within 1 ­month fol­lowing the oper­a­tion. Kink­ings are ­more fre­quent ­with the ­patch (6%) ­than ­with the ­direct ­suture (3%). The symp­to­matic resten­osis is 2%, ­while the asymp­to­matic one is 11%. The resten­osis is ­present in 8% of the ­cases ­with ­direct ­suture and in 3% of ­those ­with ­suture ­with ­patch.
Con­clu­sions. The ­local and intra­cra­nial mod­ifi­ca­tions ­after ­carotid revas­cu­lar­iza­tion ­depend on new ana­tom­ical and hemo­dy­nam­ical sit­u­a­tion due to sur­gery. The ­response of the ­wall ­which can be of ­four ­types: myoin­timal reac­tion, is a “phys­io­log­ical” ­response to the ­trauma and its thick­ness ­does not ­exceed 3 mm; myoin­timal hyper­plasia, ­with thick­ness ­exceeding 3 mm; ­early resten­osis (12 to 18 ­months); ­late resten­osis (­after 2 ­years). Sub­stan­tial dif­fer­ences in ­velocity ­between sys­tole and dias­tole and the sys­tolic ­stress ­favor hyper­plasia ­more ­than low veloc­ities ­with ­smaller dif­fer­ences.

language: English


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