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

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

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


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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.

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