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Mechanisms of Neurologic Deficits and Mortality With Carotid Endarterectomy

James F. McKinsey, MD; Tina R. Desai, MD; Hisham S. Bassiouny, MD; Giancarlo Piano, MD; Jean-Paul Spire, MD; Christopher K. Zarins, MD; Bruce L. Gewertz, MD
Arch Surg. 1996;131(5):526-532. doi:10.1001/archsurg.1996.01430170072014.
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Objective:  To evaluate the incidence and etiology of perioperative complications of carotid endarterectomy.

Design:  Retrospective review of carotid endarterectomies performed over 13 years. Risk factors, indications, results of electroencephalographic (EEG) monitoring, and outcomes were evaluated.

Setting:  University medical center.

Patients:  Three hundred sixty-seven consecutive primary carotid endarterectomies were performed on 336 patients. Indications for operation included transient ischemic attack (48.5%), asymptomatic stenosis (24%), stroke (17%), nonlateralizing ischemia (9.5%), and stroke-in-evolution (1%).

Main Outcome Measures:  Postoperative neurologic deficits (permanent and transient) and deaths were correlated with preoperative symptoms, probable mechanism of the neurologic event, intraoperative EEG changes, and the use of intraoperative shunts.

Results:  Four new permanent neurologic deficits (1.1%) and one transient postoperative deficit were noted. Of the five deficits, three were related to undiagnosed intraoperative cerebral ischemia and two were related to perioperative emboli. Three perioperative deaths (0.8%) occurred: two of myocardial infarction and one of an intracerebral hemorrhage from a ruptured arteriovenous malformation. Intraoperative EEG tracings for the most recent consecutive 175 procedures were analyzed. Shunts were used in 45 patients (26%), 38 of whom demonstrated significant EEG changes with carotid clamping.

Conclusions:  Carotid endarterectomy can be performed with a low risk of stroke (1.1%) and death (0.8%). Stroke was due to cerebral ischemia or embolization. With meticulous surgical technique, death is due to myocardial ischemia and not neurologic events.(Arch Surg. 1996;131:526-532)


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