64-detector CT angiography within 24 hours after carotid endarterectomy and correlation with postoperative stroke

Christopher P. Gallati, Minal Jain, Dushyant Damania, Abhijit R. Kanthala, Anunaya R. Jain, George E. Koch, Nancy T M Kung, Henry Z. Wang, Robert E. Replogle, Babak S. Jahromi*

*Corresponding author for this work

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Object Carotid endarterectomy (CEA) carries a small but not insignificant risk of stroke/transient ischemic attack (TIA), most frequently observed within 24 hours of surgery, which can lead to the need for urgent vascular imaging in the immediate postoperative period. However, distinguishing expected versus pathological postoperative changes may not be straightforward on imaging studies of the carotid artery early after CEA. The authors aimed to describe routine versus pathological anatomical findings on CTA performed within 24 hours of CEA, and to evaluate associations between these CTA findings and postoperative stroke/TIA. Methods The authors reviewed 113 consecutive adult patients who underwent postoperative CTA within 24 hours of CEA at a single academic institution. Presence and location of arterial "flaps," luminal "step-off," intraluminal thrombus and hematoma were documented from postoperative CTA scans. Medical records were reviewed to determine the incidence of new postoperative neurological findings. Results Postoperative CTA findings included common carotid artery (CCA) step-off (63.7%), one or more intraarterial flaps (27.4%), hematoma at the surgical site (15.9%), and new intraluminal thrombus (7.1%). Flaps were seen in the external carotid artery (ECA), internal carotid artery (ICA), and CCA in 18.6%, 9.7%, and 6.2% of patients, respectively. New postoperative neurological findings were present in 7.1% of patients undergoing CTA. Flaps (especially ICA/CCA) and/ or intraluminal thrombi were more frequently seen in patients undergoing CTA for new postoperative stroke/TIA (85.7%) versus patients undergoing CTA for routine postoperative imaging (14.3%, p = 0.002). Conclusions CTA within 24 hours of CEA demonstrates characteristic anatomical findings. CCA step-offs and ECA flaps are relatively common and clinically insignificant, whereas ICA/CCA flaps and thrombi are less frequently seen and are associated with postoperative stroke/TIA.

Original languageEnglish (US)
Pages (from-to)637-643
Number of pages7
JournalJournal of neurosurgery
Volume122
Issue number3
DOIs
StatePublished - Mar 2015

Fingerprint

Carotid Endarterectomy
Common Carotid Artery
Transient Ischemic Attack
Stroke
Internal Carotid Artery
Thrombosis
External Carotid Artery
Hematoma
Carotid Arteries
Postoperative Period
Medical Records
Blood Vessels
Computed Tomography Angiography
Incidence

Keywords

  • CT angiography
  • Carotid endarterectomy
  • Stroke
  • Vascular disorders

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Gallati, Christopher P. ; Jain, Minal ; Damania, Dushyant ; Kanthala, Abhijit R. ; Jain, Anunaya R. ; Koch, George E. ; Kung, Nancy T M ; Wang, Henry Z. ; Replogle, Robert E. ; Jahromi, Babak S. / 64-detector CT angiography within 24 hours after carotid endarterectomy and correlation with postoperative stroke. In: Journal of neurosurgery. 2015 ; Vol. 122, No. 3. pp. 637-643.
@article{e55f6a6e62f841c7a28c20607a06f8f9,
title = "64-detector CT angiography within 24 hours after carotid endarterectomy and correlation with postoperative stroke",
abstract = "Object Carotid endarterectomy (CEA) carries a small but not insignificant risk of stroke/transient ischemic attack (TIA), most frequently observed within 24 hours of surgery, which can lead to the need for urgent vascular imaging in the immediate postoperative period. However, distinguishing expected versus pathological postoperative changes may not be straightforward on imaging studies of the carotid artery early after CEA. The authors aimed to describe routine versus pathological anatomical findings on CTA performed within 24 hours of CEA, and to evaluate associations between these CTA findings and postoperative stroke/TIA. Methods The authors reviewed 113 consecutive adult patients who underwent postoperative CTA within 24 hours of CEA at a single academic institution. Presence and location of arterial {"}flaps,{"} luminal {"}step-off,{"} intraluminal thrombus and hematoma were documented from postoperative CTA scans. Medical records were reviewed to determine the incidence of new postoperative neurological findings. Results Postoperative CTA findings included common carotid artery (CCA) step-off (63.7{\%}), one or more intraarterial flaps (27.4{\%}), hematoma at the surgical site (15.9{\%}), and new intraluminal thrombus (7.1{\%}). Flaps were seen in the external carotid artery (ECA), internal carotid artery (ICA), and CCA in 18.6{\%}, 9.7{\%}, and 6.2{\%} of patients, respectively. New postoperative neurological findings were present in 7.1{\%} of patients undergoing CTA. Flaps (especially ICA/CCA) and/ or intraluminal thrombi were more frequently seen in patients undergoing CTA for new postoperative stroke/TIA (85.7{\%}) versus patients undergoing CTA for routine postoperative imaging (14.3{\%}, p = 0.002). Conclusions CTA within 24 hours of CEA demonstrates characteristic anatomical findings. CCA step-offs and ECA flaps are relatively common and clinically insignificant, whereas ICA/CCA flaps and thrombi are less frequently seen and are associated with postoperative stroke/TIA.",
keywords = "CT angiography, Carotid endarterectomy, Stroke, Vascular disorders",
author = "Gallati, {Christopher P.} and Minal Jain and Dushyant Damania and Kanthala, {Abhijit R.} and Jain, {Anunaya R.} and Koch, {George E.} and Kung, {Nancy T M} and Wang, {Henry Z.} and Replogle, {Robert E.} and Jahromi, {Babak S.}",
year = "2015",
month = "3",
doi = "10.3171/2014.10.JNS132582",
language = "English (US)",
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Gallati, CP, Jain, M, Damania, D, Kanthala, AR, Jain, AR, Koch, GE, Kung, NTM, Wang, HZ, Replogle, RE & Jahromi, BS 2015, '64-detector CT angiography within 24 hours after carotid endarterectomy and correlation with postoperative stroke', Journal of neurosurgery, vol. 122, no. 3, pp. 637-643. https://doi.org/10.3171/2014.10.JNS132582

64-detector CT angiography within 24 hours after carotid endarterectomy and correlation with postoperative stroke. / Gallati, Christopher P.; Jain, Minal; Damania, Dushyant; Kanthala, Abhijit R.; Jain, Anunaya R.; Koch, George E.; Kung, Nancy T M; Wang, Henry Z.; Replogle, Robert E.; Jahromi, Babak S.

In: Journal of neurosurgery, Vol. 122, No. 3, 03.2015, p. 637-643.

Research output: Contribution to journalArticle

TY - JOUR

T1 - 64-detector CT angiography within 24 hours after carotid endarterectomy and correlation with postoperative stroke

AU - Gallati, Christopher P.

AU - Jain, Minal

AU - Damania, Dushyant

AU - Kanthala, Abhijit R.

AU - Jain, Anunaya R.

AU - Koch, George E.

AU - Kung, Nancy T M

AU - Wang, Henry Z.

AU - Replogle, Robert E.

AU - Jahromi, Babak S.

PY - 2015/3

Y1 - 2015/3

N2 - Object Carotid endarterectomy (CEA) carries a small but not insignificant risk of stroke/transient ischemic attack (TIA), most frequently observed within 24 hours of surgery, which can lead to the need for urgent vascular imaging in the immediate postoperative period. However, distinguishing expected versus pathological postoperative changes may not be straightforward on imaging studies of the carotid artery early after CEA. The authors aimed to describe routine versus pathological anatomical findings on CTA performed within 24 hours of CEA, and to evaluate associations between these CTA findings and postoperative stroke/TIA. Methods The authors reviewed 113 consecutive adult patients who underwent postoperative CTA within 24 hours of CEA at a single academic institution. Presence and location of arterial "flaps," luminal "step-off," intraluminal thrombus and hematoma were documented from postoperative CTA scans. Medical records were reviewed to determine the incidence of new postoperative neurological findings. Results Postoperative CTA findings included common carotid artery (CCA) step-off (63.7%), one or more intraarterial flaps (27.4%), hematoma at the surgical site (15.9%), and new intraluminal thrombus (7.1%). Flaps were seen in the external carotid artery (ECA), internal carotid artery (ICA), and CCA in 18.6%, 9.7%, and 6.2% of patients, respectively. New postoperative neurological findings were present in 7.1% of patients undergoing CTA. Flaps (especially ICA/CCA) and/ or intraluminal thrombi were more frequently seen in patients undergoing CTA for new postoperative stroke/TIA (85.7%) versus patients undergoing CTA for routine postoperative imaging (14.3%, p = 0.002). Conclusions CTA within 24 hours of CEA demonstrates characteristic anatomical findings. CCA step-offs and ECA flaps are relatively common and clinically insignificant, whereas ICA/CCA flaps and thrombi are less frequently seen and are associated with postoperative stroke/TIA.

AB - Object Carotid endarterectomy (CEA) carries a small but not insignificant risk of stroke/transient ischemic attack (TIA), most frequently observed within 24 hours of surgery, which can lead to the need for urgent vascular imaging in the immediate postoperative period. However, distinguishing expected versus pathological postoperative changes may not be straightforward on imaging studies of the carotid artery early after CEA. The authors aimed to describe routine versus pathological anatomical findings on CTA performed within 24 hours of CEA, and to evaluate associations between these CTA findings and postoperative stroke/TIA. Methods The authors reviewed 113 consecutive adult patients who underwent postoperative CTA within 24 hours of CEA at a single academic institution. Presence and location of arterial "flaps," luminal "step-off," intraluminal thrombus and hematoma were documented from postoperative CTA scans. Medical records were reviewed to determine the incidence of new postoperative neurological findings. Results Postoperative CTA findings included common carotid artery (CCA) step-off (63.7%), one or more intraarterial flaps (27.4%), hematoma at the surgical site (15.9%), and new intraluminal thrombus (7.1%). Flaps were seen in the external carotid artery (ECA), internal carotid artery (ICA), and CCA in 18.6%, 9.7%, and 6.2% of patients, respectively. New postoperative neurological findings were present in 7.1% of patients undergoing CTA. Flaps (especially ICA/CCA) and/ or intraluminal thrombi were more frequently seen in patients undergoing CTA for new postoperative stroke/TIA (85.7%) versus patients undergoing CTA for routine postoperative imaging (14.3%, p = 0.002). Conclusions CTA within 24 hours of CEA demonstrates characteristic anatomical findings. CCA step-offs and ECA flaps are relatively common and clinically insignificant, whereas ICA/CCA flaps and thrombi are less frequently seen and are associated with postoperative stroke/TIA.

KW - CT angiography

KW - Carotid endarterectomy

KW - Stroke

KW - Vascular disorders

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