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  • Title: Control of the operated carotid with ultrasound. Anatomical and hemodynamical modifications, both local and intracranial.
    Author: Berni A, Cavaiola S, Carra A, Fiorellino A, Tombesi T, Tromba L.
    Journal: J Cardiovasc Surg (Torino); 1999 Feb; 40(1):27-9. PubMed ID: 10221381.
    Abstract:
    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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