Sequential morphological changes at the site of carotid endarterectomy

Abstract

✓ Nineteen carotid arteries were examined post mortem after endarterectomy had been performed from 1 hour to 11 years previously. The sequential morphological changes at the endarterectomy site were divided into acute, reparative, and mature phases. All nine occluded arteries thrombosed during the acute phase postoperatively. The degree of medial necrosis, acute inflammation and adventitial exposure was more marked in these thrombosed acute phase arteries. By 30 days new intima covered the endarterectomy site and thereafter thrombosis was not seen. Avoidable technical errors led to thrombosis of three arteries. Anticoagulation after surgery may reduce the incidence of postoperative thrombosis. Recurrent symptomatic atheroma occurred in two cases at the original endarterectomy site 16 months and 11 years after operation.