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Prevention of Neurologic Complications of Carotid Endarterectomy

Prevention of Neurologic Complications of Carotid Endarterectomy Abstract • We studied the neurologic complications after carotid endarterectomy to develop recommendations for prevention. From 1973 through June 1981, 195 carotid endarterectomies were performed on 184 patients. Carotid endarterectomy was performed using general anesthesia with routine use of a Javid shunt. There were no postoperative deaths. Three major, disabling strokes (1.5%) and four (2%) minor, permanent neurologic deficits occurred. The neurologic deficits were analyzed according to cause: (1) inadequate cranial inflow in four patients, (2) fluctuation in blood pressure requiring treatment in one third (61) of our patients, and (3) embolic complications, usually a single, transient ischemic episode, in 17 patients during the first postoperative week. This was not observed in patients receiving postoperative antiplatelet therapy. Inadequate collateral carebral inflow accounts for most permanent postoperative neurologic deficits. Postoperative hypotension is now more dangerous than hypertension. Postoperative embolization is largely preventable with antiplatelet agents. (Arch Surg 1982;117:551-555) References 1. Owens ML, Atkinson JB, Wilson SE: Recurrent transient ischemic attacks after carotid endarterectomy . Arch Surg 1980;115:482-486.Crossref 2. Owens ML, Pressman M, Edwards AE, et al: The effect of small infarcts and carotid endarterectomy on postoperative psychologic test performance . J Surg Res 1980;28:209-216.Crossref 3. Easton JD, Sherman DG: Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations . Stroke 1977;8:565-568.Crossref 4. Gundlach WJ, Swenson WM: Carotid endarterectomy in a community hospital . Surg Gynecol Obstet 1979;148:720-722. 5. West H, Burton R, Roon AJ, et al: Comparative risk of operation and expectant management for carotid artery disease . Stroke 1979;10:117-121.Crossref 6. Carmichael JD: Carotid surgery in the community hospital . Arch Surg 1980;115:937-939.Crossref 7. Hertzer NR, Beven EG: A retrospective comparison of the use of shunts during carotid endarterectomy . Surg Gynecol Obstet 1980;151:81-84. 8. White JS, Sirinek KR, Root HD, et al: Morbidity and mortality of carotid endarterectomy . Arch Surg 1981;116:409-412.Crossref 9. Gee W, McDonald KM, Kaupp HA: Carotid endarterectomy shunting: Effectiveness determined by operative ocular pneumoplethysmography . Arch Surg 1979;114:720-721.Crossref 10. Hays RJ, Levinson SA, Wylie EJ: Intraoperative measurement of carotid back pressure as a guide to operative management for carotid endarterectomy . Surgery 1972;72:953-960. 11. Machleder HI, Barker WF: External carotid artery shunting during carotid endarterectomy . Arch Surg 1974;108:785-788.Crossref 12. Towne JB, Bernhard VM: The relationship of postoperative hypertension to complications following carotid endarterectomy . Surgery 1980; 88:575-580. 13. Caplan LR, Skillman J, Ojemann R, et al: Intracerebral hemorrhage following carotid endarterectomy: A hypertensive complication? Stroke 1978;9:457-460.Crossref 14. Whisnant JP: Epidemiology of stroke: Emphasis on transient cerebral ischemic attacks and hypertension . Stroke 1974;5:68-70.Crossref 15. Fields WS, Lemak NA: Joint study of extracranial arterial occlusion: IX. Transient ischemic attacks in the carotid territory . JAMA 1976; 235:2608-2610.Crossref 16. Goldner JC, Whisnant JP, Taylor WF: Long-term prognosis of transient cerebral ischemic attacks . Stroke 1971;2:160-167.Crossref 17. Millikan CH: Reassessment of anticoagulant therapy in various types of occlusive cerebrovascular disease . Stroke 1971;2:201-208Crossref 18. Javid H, Ostermiller WE, Hengesh JW, et al: Natural history of carotid bifurcation atheroma . Surgery 1970;67:80-86. 19. Busuttil RW, Baker JD, Davidson RK, et al: Carotid artery stenosis: Hemodynamic significance and clinical course . JAMA 1980;245:1438-1441.Crossref 20. Kartchner MM, McRae LP: Noninvasive evaluation and management of the 'asymptomatic' carotid bruit . Surgery 1977;82:840-847. 21. Debokey MD, Crawford SE, Cooley DA, et al: Cerebral artery insufficiency: One to 11-year results following arterial reconstructive operation . Ann Surg 1964;161:921-945.Crossref 22. Deweese JA, Rob CG, Satran R, et al: Results of carotid endarterectomies for transient ischemic attacks: Five years later . Ann Surg 1973; 178:258-264.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Prevention of Neurologic Complications of Carotid Endarterectomy

Archives of Surgery , Volume 117 (5) – May 1, 1982

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Publisher
American Medical Association
Copyright
Copyright © 1982 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1982.01380290023005
Publisher site
See Article on Publisher Site

Abstract

Abstract • We studied the neurologic complications after carotid endarterectomy to develop recommendations for prevention. From 1973 through June 1981, 195 carotid endarterectomies were performed on 184 patients. Carotid endarterectomy was performed using general anesthesia with routine use of a Javid shunt. There were no postoperative deaths. Three major, disabling strokes (1.5%) and four (2%) minor, permanent neurologic deficits occurred. The neurologic deficits were analyzed according to cause: (1) inadequate cranial inflow in four patients, (2) fluctuation in blood pressure requiring treatment in one third (61) of our patients, and (3) embolic complications, usually a single, transient ischemic episode, in 17 patients during the first postoperative week. This was not observed in patients receiving postoperative antiplatelet therapy. Inadequate collateral carebral inflow accounts for most permanent postoperative neurologic deficits. Postoperative hypotension is now more dangerous than hypertension. Postoperative embolization is largely preventable with antiplatelet agents. (Arch Surg 1982;117:551-555) References 1. Owens ML, Atkinson JB, Wilson SE: Recurrent transient ischemic attacks after carotid endarterectomy . Arch Surg 1980;115:482-486.Crossref 2. Owens ML, Pressman M, Edwards AE, et al: The effect of small infarcts and carotid endarterectomy on postoperative psychologic test performance . J Surg Res 1980;28:209-216.Crossref 3. Easton JD, Sherman DG: Stroke and mortality rate in carotid endarterectomy: 228 consecutive operations . Stroke 1977;8:565-568.Crossref 4. Gundlach WJ, Swenson WM: Carotid endarterectomy in a community hospital . Surg Gynecol Obstet 1979;148:720-722. 5. West H, Burton R, Roon AJ, et al: Comparative risk of operation and expectant management for carotid artery disease . Stroke 1979;10:117-121.Crossref 6. Carmichael JD: Carotid surgery in the community hospital . Arch Surg 1980;115:937-939.Crossref 7. Hertzer NR, Beven EG: A retrospective comparison of the use of shunts during carotid endarterectomy . Surg Gynecol Obstet 1980;151:81-84. 8. White JS, Sirinek KR, Root HD, et al: Morbidity and mortality of carotid endarterectomy . Arch Surg 1981;116:409-412.Crossref 9. Gee W, McDonald KM, Kaupp HA: Carotid endarterectomy shunting: Effectiveness determined by operative ocular pneumoplethysmography . Arch Surg 1979;114:720-721.Crossref 10. Hays RJ, Levinson SA, Wylie EJ: Intraoperative measurement of carotid back pressure as a guide to operative management for carotid endarterectomy . Surgery 1972;72:953-960. 11. Machleder HI, Barker WF: External carotid artery shunting during carotid endarterectomy . Arch Surg 1974;108:785-788.Crossref 12. Towne JB, Bernhard VM: The relationship of postoperative hypertension to complications following carotid endarterectomy . Surgery 1980; 88:575-580. 13. Caplan LR, Skillman J, Ojemann R, et al: Intracerebral hemorrhage following carotid endarterectomy: A hypertensive complication? Stroke 1978;9:457-460.Crossref 14. Whisnant JP: Epidemiology of stroke: Emphasis on transient cerebral ischemic attacks and hypertension . Stroke 1974;5:68-70.Crossref 15. Fields WS, Lemak NA: Joint study of extracranial arterial occlusion: IX. Transient ischemic attacks in the carotid territory . JAMA 1976; 235:2608-2610.Crossref 16. Goldner JC, Whisnant JP, Taylor WF: Long-term prognosis of transient cerebral ischemic attacks . Stroke 1971;2:160-167.Crossref 17. Millikan CH: Reassessment of anticoagulant therapy in various types of occlusive cerebrovascular disease . Stroke 1971;2:201-208Crossref 18. Javid H, Ostermiller WE, Hengesh JW, et al: Natural history of carotid bifurcation atheroma . Surgery 1970;67:80-86. 19. Busuttil RW, Baker JD, Davidson RK, et al: Carotid artery stenosis: Hemodynamic significance and clinical course . JAMA 1980;245:1438-1441.Crossref 20. Kartchner MM, McRae LP: Noninvasive evaluation and management of the 'asymptomatic' carotid bruit . Surgery 1977;82:840-847. 21. Debokey MD, Crawford SE, Cooley DA, et al: Cerebral artery insufficiency: One to 11-year results following arterial reconstructive operation . Ann Surg 1964;161:921-945.Crossref 22. Deweese JA, Rob CG, Satran R, et al: Results of carotid endarterectomies for transient ischemic attacks: Five years later . Ann Surg 1973; 178:258-264.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: May 1, 1982

References