Detecting Defects after Carotid Endarterectomy: A Comparison between HFUS vs. Angiography


This case illustrates how ultrasound imaging enables more correct detection of higher-grade defects than angiography after CEA. The case is provided by the authors of the CIDAC Study.

Patient Information

72-year-old male with asymptomatic 90% Internal Carotid Artery Stenosis.

Intraoperative completion control

An endarterectomy of the internal carotid was performed. A grade 3 defect was detected with High-Frequency Ultrasound (HFUS), and as seen in video 1, there is residual plaque at the distal end of the reconstruction site. In comparison, there were no findings on angio, see image 1.


Video 1: HFUS pre revision

Based on the finding by HFUS, the residual plaque was removed during revision. Image 2 shows the structures that were removed. Post revision there were still small structures left but they were considered irrelevant, see video 2. These small structures were not visible during open surgery.



Video 2: HFUS post revision

Transit Time Flow Measurement confirmed adequate flow of 329 ml/min with a PI of 1,5 post revision, see image 3.

Technology used

Medistim MiraQTM Vascular System with L15 HFUS probe, TTFM probes and angiography.


CIDAC study: “Prospective Comparison of Duplex Ultrasound and Angiography for Intraoperative Completion Studies after Carotid Endarterectomy.”

Christoph Knappich, Sofie Schmid, Pavlos Tsantilas, Michael Kallmayer, Michael Salvermoser, Alexander Zimmermann, Hans-Henning Eckstein *. Department for Vascular and Endovascular Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. Eur J Vasc Endovasc Surg (2020) 59, 881- 889.

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