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Journal of Neurosurgical Sciences 2001 December;45(4):206-12

lingua: Inglese

Carotid endar­te­rec­to­my: a ret­ro­spec­tive anal­y­sis. Microendarterectomy and trans­cra­ni­al Doppler ultra­sound mon­i­tor­ing

Russo G., Di Maro D., Grasso U., Daniele B.

Operative Unit of Neurosurgery and Neurotrauma, ­AORN “A. Cardarelli”, Naples, Italy


Background. Analyses of the ­results ­obtained fol­low­ing our pro­to­col for the sur­gi­cal ther­a­py of carot­id ­artery sten­o­sis is the aim of ­this ­study.
Methods. Ninety-one pro­ce­dures ­were per­formed on 84 ­patients by the ­same sur­gi­cal ­team. Indications for carot­id endar­te­rec­to­my (CEA) ­were 50-70% internal carotid artery (ICA) sten­o­sis in 8% of the ­patients (100% symp­to­mat­ic), 70-90% sten­o­sis in 67% (64% symp­to­mat­ic) and 90-99% ICA sten­o­sis in 25% of our ­patients (33% symp­to­mat­ic). Carotid ­shunt dur­ing arte­ri­al ­cross-­clamp was ­only ­used in 4 cas­es (4.4%) fol­low­ing trans-cranial Doppler ultrasound (TCD) intra­op­er­a­tive mon­i­tor­ing find­ings. Operative micro­scope or sur­gi­cal ­loupes ­were ­used for the com­plete remov­al of ather­o­ma and the ­direct ­suture of the arter­i­ot­o­my. Heparin was ­only antag­on­ised in select­ed cas­es.
Results. No mor­tal­ity and no per­ma­nent def­i­cit relat­ed to ischem­ic ­events ­were ­present in our ­patients; a tran­sient neu­ro­log­i­cal def­i­cit ­occurred in 1 ­case (1.1%). Two ­patients ­died (2.2%): 1 due to myo­car­dial infarc­tion and the sec­ond one to bron­chop­neu­mo­nia. Transient periph­er­al ­nerve def­i­cits ­were not­ed in 2 cas­es.
Conclusions. In ­order to ­reduce to a min­i­mum ischem­ic ­risks dur­ing CEA, our pre­lim­i­nary expe­ri­ence advis­es micro­sur­gi­cal tech­nique for the com­plete remov­al of the ather­o­ma and ­suture, TCD eval­u­a­tion of col­lat­er­al ­reserve dur­ing ­cross-clamp­ing, and the use of ran­dom­ised mul­ti­cen­ter stud­ies guide­lines for the selec­tion of ­patients. More atten­tion ­must ­also be giv­en to post­op­er­a­tive ­care, ­since hemo­dy­nam­ic instabil­ity rep­re­sents the ­main ­risk for our ­patients. Overnight inten­sive ­care ­unit (ICU) sur­veil­lance in all ­patients may ­help to ­avoid ­fatal com­pli­ca­tions.

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