1 3 Surg Today DOI 10.1007/s00595-014-1018-x ORIGINAL ARTICLE Asymptomatic dissecting intimal lesions of common carotid arteries after carotid endarterectomy Hrvoje Budincevic · Ante Ivkosic · Miran Martinac · Tomislav Trajbar · Ivan Bielen · Laszlo Csiba Received: 3 December 2013 / Accepted: 12 August 2014 © Springer Japan 2014 antithrombotic therapy or due to a need to perform an end- ovascular treatment. Keywords Carotid endarterectomy · Intimal lesions · Carotid ultrasound Purpose Stroke is the leading cause of disability worldwide [1]. Approximately 20 % of ischemic strokes are caused by carotid artery disease [2]. Carotid ultrasound has a major role in the evaluation of carotid disease [3]. According to the international guidelines, carotid endarterectomy is recommended for patients with symptomatic high-grade stenosis of the internal carotid artery and may be recom- mended for patients with symptomatic moderate-grade and asymptomatic high-grade stenosis with a high risk of ischemic stroke [3, 4]. The most common types of carotid surgery are longitudinal and eversion carotid endarterec- tomy, while the use of patches and shunting are not manda- tory for all cases [3, 4]. The aim of this study was to present the characteristics and possible causes of asymptomatic dissecting intimal lesions following carotid endarterectomy. Methods A retrospective evaluation of the frequency and charac- teristics of asymptomatic dissecting intimal lesions of the common carotid arteries was performed in a sample of 100 patients who underwent endarterectomy due to symptomatic high-grade stenosis of the internal carotid artery. These patients were regularly examined in the Abstract Purpose Carotid endarterectomy is a standard treatment for symptomatic high-degree internal carotid artery ste- nosis. The aim of this article is to present possible intimal lesions after carotid endarterectomy. These lesions could be manifested as intimal flaps, intimal steps or dissections with or without occlusion or stenosis of the artery. Methods The evaluation of the frequency and character- istics of the asymptomatic dissecting intimal lesions of the common carotid arteries was performed in a sample of 100 patients who underwent endarterectomy for symptomatic high-grade stenosis of the internal carotid artery. Results We found five patients with asymptomatic dis- secting intimal lesions of the common carotid arteries. Conclusion The most common causes of these intimal lesions were shunting and prolongation of the clamping time. Routine carotid ultrasound follow-up exams are nec- essary because of the potential need for a change in the H. Budincevic (*) Stroke and Intensive Care Unit, Department of neurology, University Hospital “Sveti Duh”, Sveti Duh 64, 10000 Zagreb, Croatia e-mail: hbudincevic@gmail.com A. Ivkosic · M. Martinac · T. Trajbar Department of surgery, University Hospital “Sveti Duh”, Sveti Duh 64, 10000 Zagreb, Croatia I. Bielen Department of neurology, University Hospital “Sveti Duh”, Sveti Duh 64, 10000 Zagreb, Croatia L. Csiba Department of neurology, Medical and Health Science Center, University of Debrecen, Nagyerdei Körút 98, P.O. Box 48, Debrecen, Hungary