Determining Changes in Diameter of Internal Carotid Artery Before and After Primary Repair in Carotid Endarterctomy.

Introduction and Purposes: Cerebrovascular accident (CVA) is the third leading cause of death worldwide. The most common cause of CVA is obstructive lesions of the proximal internal carotid artery, for which a variety of surgical and nonsurgical therapeutic modalities have been proposed. In the surgical approach (carotid endarterectomy) several different methods have been employed for arterial repair which include primary repair, synthetic or autologous venous patches and eversion endarterectomy. These different methods have led to different outcomes in terms of postoperative arterial diameter and the development of restenosis.
The present article aims at studying the changes in internal carotid artery diameter after primary repair in patients undergoing carotid endarterectomy in shohada-e Tajrish medical center, vascular surgery department.

Materials and Methods: A descriptive cross-sectional clinical study was carried out on 42 operations of carotid endarterectomy performed on 36 patients (Six patients were operated on bilaterally). Arterial repair was uniformly performed by primary repair. The diameter of the artery was exactly measured by a special caliper before and after the operation. Follow-up assessment was performed by color Doppler ultrasound 6 monthsafter surgery. Any variation in the arterial diameter or development of restenosis was recorded in individual questionnaires and results were statistically analyzed.

Results: In 42 primary repairs of internal carotid artery we had an increase in post operative arterial diameter in 40.5% of cases with a mean increment of 3.17 percent. In 14.2 percent there was no change and in45.3 percent the arterial diameter decreased with a mean of 2.8 percent. Statistically the latter figure was not considered significant based on a T-test study. Follow-up color Doppler ultrasound performed 6 months after the operation revealed a stenosis up to 25% in 22.7% of patients which was not statistically significant.

Conclusion: This study shows that primary repair of internal carotid artery after carotid endarterectomy does not result in narrowing or recurrent stenosis and therefore could be considered as a safe and satisfactory method of arterial repair. However, the authors recommend further controlled trials to compare this practice with the other methods of arterial repair.