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

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.