Introduction: Carotid endarterectomy (CEA) is indicated in stroke prevention with a combined perioperative stroke and mortality rate of less than 3% in asymptomatic patients. Currently there is no consensus on routine completion imaging to assess the results of CEA. This video presentation demonstrates the usefulness of intraoperative duplex ultrasound in detecting acute thrombus formation and prevention of stroke during carotid endarterectomy.

Methods: Intra-operative duplex ultrasound is routinely utilized following carotid endarterectomy. A GE Logiq 9 duplex ultrasound machine and a linear 12 MHz intraoperative probe within a sterile sheath are used. This is performed after completion of the patch angioplasty to evaluate for remaining luminal stenosis, intimal flap, or thrombus and to measure baseline hemodynamic velocities.

Results: A mobile intravascular thrombus was detected at the endarterectomy site with the risk of cerebral embolization or carotid artery thrombosis. This finding necessitated immediate opening of the vessel and removal of the thrombus. Repeat ultrasound confirmed luminal patency without remnant thrombus and normal flow velocities. The patient had an uneventful recovery postoperatively.

Conclusion: Routine intra-operative completion duplex ultrasound can successfully detect thrombus formation and help decrease the incidence of perioperative stroke. This potentially catastrophic finding can be immediately rectified with minimal additional patient morbidity.