The application of duplex surveillance after carotid intervention.

Carotid duplex ultrasound testing provides a safe and accurate method to detect and grade the severity of atherosclerotic internal carotid artery stenosis both before and following carotid intervention. Testing after surgical endarterectomy or stent angioplasty allows assessment of the technical success by excluding residual stenosis. The focus of duplex surveillance after carotid intervention is to identify recurrent stenosis, repair site occlusion, and progression of contralateral internal carotid artery disease. Patients who develop a neurologic event or a duplex-detected >75% diameter-reducing internal carotid artery stenosis with a peak systolic velocity >300 cm/s and end-diastolic velocity >125 cm/s should be further evaluated by angiographic imaging and should be considered for reintervention if an appropriate lesion is confirmed. Duplex surveillance allows the vascular surgeon to evaluate patency of the rendered intervention, its stenosis-free durability, and its effectiveness in stroke prevention.