Perioperative ischemic complications of the brain after carotid endarterectomy

Neurosurgery
Matthew O HebbRobert F Spetzler

Abstract

The potential morbidity of cerebral ischemia after carotid endarterectomy (CEA) has been recognized, but its reported incidence varies widely. To prospectively evaluate the development of cerebral ischemic complications in patients treated by CEA at a high-volume cerebrovascular center. Fifty patients with moderate or severe carotid stenosis awaiting CEA were studied with perioperative diffusion-weighted imaging of the brain and standardized neurological evaluations. Microsurgical CEA was performed by 1 of 2 vascular neurosurgeons. Radiological studies were evaluated by faculty neuroradiologists who were blinded to the details of the clinical situation. Preoperative diffusion-weighted imaging studies were performed within 24 hours of surgery. A second study was obtained within 24 (92% of patients), 48 (4% of patients), or 72 (4% of patients) hours after surgery. Intraluminal shunting was used in 1 patient (2%), and patch angioplasty was used in 2 patients (4%). No patient had diffusion-weighted imaging evidence of procedure-related cerebral ischemia. Nonischemic complications consisted of postoperative confusion in an 87-year-old man with a urinary tract infection and a marginal mandibular nerve paresis in another patient. Radi...Continue Reading

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Citations

Apr 11, 2013·Expert Review of Cardiovascular Therapy·Joseph L Blackshear, Thomas G Brott
Dec 3, 2014·The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland·Ashley K Vavra, Mark K Eskandari
Oct 1, 2013·World Neurosurgery·Rami O Almefty, Robert F Spetzler
Apr 25, 2014·Annals of Surgical Treatment and Research·Jae Hoon Lee, Bo Yang Suh
Jan 12, 2016·World Neurosurgery·Richard W Williamson, Robert F Spetzler
Sep 10, 2011·Neurosurgery·Georgios ZenonosRobert Max Friedlander

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