Inadequate cerebral perfusion is an unlikely cause of perioperative stroke

Annals of Vascular Surgery
E G WhitneyD G Whitney

Abstract

The purpose of this study was to determine the importance of hypoperfusion ischemia as a cause of stroke during carotid endarterectomy (CEA). A retrospective analysis of 128 consecutive CEA procedures were examined in patients at risk for hypoperfusion ischemia, namely, patients with occlusion of the contralateral carotid artery. All procedures were performed under general anesthesia without the use of a temporary indwelling shunt. Sixty-one percent of patients had cerebrovascular symptoms preoperatively and 39% were asymptomatic. The degree of stenosis of the carotid artery was 80%-99% in 67% (86/128) of patients, 60%-79% in 25% (32/128), 20%-59% in 7% (9/128), and 0-19% in 0.8% (1/128). The perioperative mortality was 0.8% (1/128), the incidence of permanent neurologic morbidity was 1.6% (2/128), and the incidence of transient neurologic morbidity was 3.9% (5/128). In conclusion, these data suggest that hypoperfusion ischemia is a rare cause of stroke during CEA even in patients with occlusion of the contralateral carotid artery and that CEA can be performed safely even in patients with contralateral occlusion without the use of a temporary indwelling shunt.

Citations

Feb 24, 2009·British Journal of Anaesthesia·M D Stoneham, J P Thompson
Feb 16, 2008·Neurosurgical Focus·Jonathan Andrew Curtis, Kaj Johansen
Apr 14, 2012·The Korean Journal of Thoracic and Cardiovascular Surgery·Tae Yun KimHyun Kyu Park
Dec 16, 2005·Neurological Research·Miguel A MelgarMartin Weinand
Sep 8, 2009·Annals of Vascular Surgery·James H BlackCalvin E Jones
Apr 1, 2008·Journal of Cardiothoracic and Vascular Anesthesia·Ritesh Maharaj
Feb 15, 2018·Korean journal of anesthesiology·Sang-Bae Ko
May 22, 1998·Stroke; a Journal of Cerebral Circulation·S ZannettiP Cao
Aug 7, 2007·Expert Review of Neurotherapeutics·Uma MenonRoger E Kelley

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