Abstract
We read with interest the paper by Roth and colleagues regarding requirement for duplex surveillance following carotid endarterectomy.1Roth SM Back MR Bandyk DF Avino AJ Riley V Johnson BL A rational algorithm for duplex scan surveillance following carotid endarterectomy.J Vasc Surg. 1999; 30: 453-460Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar We have similarly looked at this issue and previously published in the Journal of Vascular Surgery.2Golledge J Cummin R Ellis M Beattie DK Davies AH Greenhalgh RM Clinical follow-up rather than duplex surveillance after carotid endarterectomy.J Vasc Surg. 1997; 25: 55-63Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar In contrast to Roth and colleagues, we followed a conservative path with respect to asymptomatic contralateral carotid artery disease and restenosis. We only treated patients who developed symptoms in association with a tight stenosis. We related development of ipsilateral or contralateral stroke during follow-up to the presence of contralateral carotid artery disease at the time of operation, in addition to the development of ipsilateral restenosis or progression of contralateral carotid artery disease. We found no relationship between development of restenosis and ipsilateral stroke. Similarly, there was no relationship between the presence of tight contralateral stenosis and subsequent contralateral stroke, nor was there a relationship between the progression of contralateral artery disease and subsequent contralateral stroke. On the basis of this, our data would support a conservative approach to restenosis and contralateral carotid artery disease. We feel that long-term duplex surveillance following carotid endarterectomy is unwarranted on these data, and funds would be better spent elsewhere.
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