Thrombus detected with HFUS after CEA


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

83-year-old male, 90% left ICAS, 70% right ICAS

Intraoperative Completion Control

An endarterectomy at the upper part of the internal carotid was performed. A grade 4 defect was detected with HFUS, in comparison, angiography only showed a grade 2 defect. See image 1 and video 1.
The ultrasound imaging video clearly shows the thrombus in the lumen, visualized both by a cross-sectional and a longitudinal view. Based on the finding, a revision was performed and the thrombus was removed.
Post revision:
A nice, clean lumen is seen after revision and the flow measurement (TTFM) was acceptable, as seen in images 2 and 3.


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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