ORIGINAL ARTICLES   

Gazzetta Medica Italiana Archivio per le Scienze Mediche 2004 December;163(6):239-42

Copyright © 2004 EDIZIONI MINERVA MEDICA

language: English

Short clamping time and thiopental sodium protection in carotid endarterectomy. Perioperative results

Fuseri M. ¹, Nicoletti A. ¹, Biglioli P. ²

¹ Vascular and Endovascular Surgery Unit, Monza Polyclinic, Monza, Italy; ² Cardiovascular Department, IRCCS Monzino Foundation, University of Milan, Milan, Italy

Aim. The pur­pose of ­this ­study was to eval­u­ate the ef­fi­ca­cy of a min­i­mal­ly in­va­sive ca­rot­id en­dar­te­rec­to­my (CEA) stan­dard tech­nique as­so­ciat­ed ­with thi­o­pen­tal so­di­um (Penthotal) ce­re­bral pro­tec­tion as an al­ter­na­tive to rou­tine shunt­ing.
Methods. A ret­ro­spec­tive con­sec­u­tive se­ries of 100 ca­rot­id en­dar­te­rec­to­mies was re­viewed. All CEAs ­were per­formed for symp­to­mat­ic or asymp­to­mat­ic ca­rot­id sten­o­sis >70% ­under gen­er­al an­es­the­sia and thi­o­pen­tal so­di­um ce­re­bral pro­tec­tion ­with elec­tro­en­ce­phal­o­graph­ic con­trol. A stan­dard CEA ­with a lon­gi­tu­di­nal ar­ter­i­ot­o­my of the com­mon ca­rot­id ar­tery and a min­i­mal ar­ter­i­ot­o­my of the inter­nal ca­rot­id ar­tery was per­formed in all cas­es. No intra­lu­mi­nal ­shunt was ­used in fa­vour of thi­o­pen­tal ce­re­bral pro­tec­tion. Clinical ex­am­ina­tion and a col­or du­plex ­scan ­were per­formed at 1 ­month af­ter sur­gery.
Results. In ­this se­ries we had no ­death, 1 ma­jor ­stroke and 2 tran­sient is­chem­ic neu­ro­log­i­cal def­i­cits. All def­i­cits ­were ip­si­lat­er­al and re­lat­ed to tech­ni­cal com­pli­ca­tions rath­er ­than ­failed ce­re­bral pro­tec­tion. Non-neu­ro­log­i­cal com­pli­ca­tions in­clud­ed 2 symp­tom-­free re­cur­rent sten­o­sis >50% at 1 ­month and 2 cra­ni­al ­nerve in­ju­ries. No ear­ly ca­rot­id oc­clu­sion, ­wound he­mat­o­ma or myo­car­dial in­farc­tion ­were re­cord­ed.
Conclusion. In ­this se­ries CEA as­so­ciat­ed ­with a ­short clamp­ing ­time and thi­o­pen­tal so­di­um ce­re­bral pro­tec­tion has ­been ef­fec­tive in ­terms of low is­chem­ic ­stroke ­rate, pa­ten­cy ­rate and ­speed of sur­gery. Further fol­low-up is nec­es­sary to eval­u­ate re­cur­rent sten­o­sis ­rate.