Background.The study emphasises the importance of accurate preoperative evaluation of patients, the usefulness of transcranial Doppler monitoring, selective shunting and a women Dacron patch ...angioplasty following carotid endarectomy. Patients, methods and results. Since 1982, more than 700 Dacron patch angioplasties of the carotid artery have been performed at our institution. A restrospective study of 412 carotid reconstructions in 386 patients, performed between July 1982 and January 1990, showed that there were seven deaths during surgery (1.7%) and twelve perioperative strokes (2..9%). Indications for carotid endarterectomy were transient ischemic attacks in 192 cases (46.5%), significant asymptomatic carotid lesion in 123 cases (30%) and a prior major stroke in 97 cases (23.5%). In this series therewere no Dacron patch infections or postoperative aneurysms. On the basis of these observations, a prospective study was conducted on 192 patients (meanage 67 years) with 211 carotid endarterectomies performed between January 1990 and January 1997. Surgery was performed for transient ischemic attacks in 159 cases, stroke in 18 and non-hemispheric symptoms in 34 cases. Perioperative transcranial Doppler monitoring was performed in 91 patients with carotid endarterectomy. Internal shunts were used selectively. Patients underwent duplex scanning one week following surgery and yearly thereafter. Thirty-two patients (15.2%) were lost to follow-up; hence 179 arteries were followed in 173 patients for 12-84 (mean 45.8) months. There was one wound infection and a postoperative aneurysm in the same patient. The incidence of residual stenosis on the one-week scan was 3.9% (7 carotid endartectomies) and that of recurrent stenosis 5% (9 carotid endarterectomies) . Conclusions. Under conditions of appropriate indications and selective use of TCD, a carotid Dacron patch angioplasty after a carotid endarterectomy is associated with very good results.
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