Background: This study aims to review the relationship of new ischemia and perioperative stroke with plaque morphology in routine carotid shunt used and saphenous vein patch plasty applied carotid endarterectomy patients.

Methods: The study included 25 patients (21 males, 4 females; mean age 69±8.3 years; range 47 to 84 years) who had 70% and higher carotid stenosis and were planned to undergo carotid endarterectomy. Of the patients, three (12%) were asymptomatic and 22 (88%) were symptomatic. All patients were administered diffusion magnetic resonance (MR) imaging perioperatively and at postoperative first day. Operations were performed under general anesthesia. Routine carotid shunt was used and arteriotomies were closed with saphenous ven patch. Endarterectomy materials were examined pathologically. Preoperative and postoperative diffusion MR images were compared and evaluated for neurologic pathologies and complications.

Results: Fibrosis was detected in six patients (24%), calsification in nine patients (36%), ulceration in four patients (16%), and thrombosis in six patients (24%). Preoperative diffusion MR imaging revealed ipsilateral lesion in five patients (20%). Diffusion MR imaging conducted at postoperative first day showed new ischemic lesion in five patients (20%). Although new ischemic lesions were detected in five patients, there was no postoperative neurologic complication. Of new ischemic lesion detected patients, three had calsification, one had ulceration, and one had thrombosed plaque.

Conclusion: Although calcific plaques, perioperative hypotension and high cholesterol levels were seen in our endarterectomy group, there was no statistically significant relationship between them.

Keywords : Carotid artery plaque; carotid stenosis; diffusion magnetic resonance imaging; endarterectomy