Ultrasonic Endarterectomy: Experimental and Initial Clinical Results in Carotid Stenosis

Abstract

Purpose: The effects of ultrasonic endarterectomy, evaluated experimentally and clinically, were compared with the results obtained with conventional endarterectomy. Methods: Experimental: An ultrasonic vascular dissector with a frequency of 29 kHz was used for ultrasonic endarterectomy. Gross and histologic observation was made on 22 fresh human cadaver atherosclerotic vessels, of which 16 were treated with ultrasound endarterectomy and 6 conventionally. Clinical: Twenty-eight patients requiring carotid endarterectomy were chosen at random. Seven patients underwent ultrasonic endarterectomy after traditional access surgery, while 21 patients were treated with conventional endarterectomy. In the clinical study, an intraoperative gross observation of the endarterectomized surfaces was made, followed by duplex scanning after 18 and 24 months. Results: Histologic observation of the cadaveric vessels revealed particularly smooth surfaces in 87.5%; there was no debris, flaps, or vessel damage in any of the ultrasonically treated samples. In contrast, the traditional technique produced regular surfaces without residual debris in only 50% of the experimental cases. Favorable results were also seen in the clinical carotid experience, in which there was no need to surgically correct the ultrasonically endarterectomized surface in any case. In fact, achieving a satisfactory outcome was greatly facilitated by the use of ultrasound. In the conventionally treated patients, however, only 19% (4) demonstrated a smooth luminal surface on gross observation even after surgical correction. No postoperative complications were encountered in either group, and no restenosis has occurred in ultrasonic endarterectomy-treated patients after 2 years. Conclusions: Favorable experimental results using ultrasonic endarterectomy prompted the successful clinical application of this new technique in carotid stenosis treatment. Whether or not ultrasonic endarterectomy can reduce postoperative morbidity and restenosis is still under study.