Management options for post carotid endarterectomy stroke.

Abstract

BACKGROUND:

Management of acute thrombosis of the carotid artery has been controversial. This retrospective study reviews the etiology and analyzes the management options of post carotid endarterectomy stroke.

METHODS:

Diagnosis was made using oculopneumop-lethysmography (OPG/Gee), duplex ultrasound, computed tomography (CT) scanning, and carotid exploration.

RESULTS:

The cause of stroke was identified as carotid thrombosis in 19/32 patients (59%) and non-carotid thrombosis in 13. Management options included nine patients who underwent selective carotid exploration and all had a thrombosed carotid; mandatory exploration-six were explored and three had a thrombosed carotid artery; and 17 patients had no exploration (medical treatment). Fourteen patients had a positive OPG, 13 were confirmed to have carotid thrombosis. Eight patients had a negative OPG and all were confirmed. The OPG had an overall accuracy of 95% in detecting postoperative thrombosis (89% specificity and 100% sensitivity). Patients with thrombosed carotids and patients with positive OPGs had more severe neurological deficits than those with non-thrombosed carotids. The final neurological status of the 12 patients with carotid thrombosis who underwent thrombectomy and patch angioplasty was improved (7/12) in contrast to the seven patients who did not undergo a thrombectomy (1/7). Seven of nine patients had a complete or good recovery when thrombectomy was done within two hours of the stroke in contrast to 0/3 after two hours. Seven of ten patients with Grade II stroke (moderate) had a good recovery after carotid exploration and thrombectomy in contrast to 0/2 for Grade III (severe) stroke.

CONCLUSIONS:

Carotid artery thrombosis, the most common cause of post carotid endarterectomy stroke, can be detected by OPG/Gee. Immediate carotid exploration for patients with Grade I or II strokes, when thrombosis is demonstrated, can improve the results of carotid endarterectomy.

• Authors: A F Aburahma, P A Robinson, Y S Short
• Journal: The Journal of cardiovascular surgery (J Cardiovasc Surg (Torino)) Vol. 37 Issue 4 Pg. 331-6 (Aug 1996) ISSN: 0021-9509 [Print] Italy
• PMID: 8698774 (Publication Type: Journal Article)

Topics

• Aged
• Aged, 80 and over
• Carotid Artery Thrombosis (etiology, surgery)
• Cerebrovascular Disorders (diagnosis, etiology, therapy)
• Endarterectomy, Carotid (adverse effects)
• Female
• Humans
• Intraoperative Complications
• Male
• Middle Aged
• Postoperative Complications
• Retrospective Studies
• Thrombectomy