Changes in Geometry and Hemodynamics After Carotid Endarterectomy

Background : Many studies on cerebral atherosclerosis and its treatment have been conducted over the past 60 years. Several modifications of open surgical treatment (carotid endarterectomy) have been proposed. There are several techniques of carotid endarterectomy; however, there is no consensus on advantages of any of these techniques. Objective : To analyze the anatomy and geometry of the common carotid artery bifurcation in patients with hemodynamically significant stenoses of the internal carotid artery. Materials and methods : To study geometric parameters, we used computed tomography data of patients operated on at the Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). The patients underwent the following procedures: classical, eversion, or glomus-sparing carotid endarterectomy. We built geometric models using specialized software and studied hemodynamics at the common carotid artery bifurcation in the early postoperative period (1 day after surgery) and 1 year after surgery. Results and conclusion : Zones at risk for atherosclerotic plaque formation are mainly in the common carotid artery. This phenomenon is explained by the surgery technique, namely, by the fact that the cut line of the atherosclerotic plaque is located in this region. Models built on the basis of computed tomographic angiograms 1 year after surgery demonstrate a decrease in the area of zones at risk. This might be due to the arterial wall smoothing and neointima formation.