[Intra and postoperative control in carotid surgery].

After fourty years of practice in carotid surgery the rate of neurologic complications related to technical defects seems not to be reduced and still is responsible of 30-40% of all perioperative strokes. Intraoperative quality control seem at present, of outmost importance to further reduce the impact of technical defects on perioperative neurological complications. Angiography, Duplex Scanning and more recently angioscopy have been utilized as intraoperative assessments. All of them demonstrated imperfections of arterial reconstruction potentially at risk for early and late patency failure and indicated immediate intraoperative correction. In some report this behaviour determined a relevant reduction both on perioperative results and lesser incidence of early restenosis. Concerning postoperative control of carotid endarterectomy early restenosis represent the most important and more common failure after carotid endarterectomy. In spite of the efforts to clear the causes of this phenomenon, none of the numerous papers published in literature has defined a specific cause determining restenosis. Nevertheless, at present, this hyperplastic response of the arterial wall to trauma after operation is generally considered benign because rarely is responsible for new neurological symptoms or early internal carotid artery occlusion. This unanimous conviction has been achieved after years of instrumental and clinical postoperative follow-up performed all over the world. At the same time and probably for the above mentioned reasons, recently, has begun a new discussion about the usefulness and cost-effectiveness of prolonged Duplex scanning postoperative surveillance of the endarterectomized carotid arteries. After a meticolous review of our experience as the review of many reports of literature we, in agreement with others, are convinced that the patients operated of carotid endarterectomy, need, in most cases, a short even aggressive period of careful follow up (generally the first six months). If during this period no irregularities or new stenosis is detected at the site of the endarterectomy, we believe that it is justified the patients to be withdrawn from a prolonged instrumental follow-up, permitting laboratory working time to be redirected towards the diagnosis of new vascular diseases.