ORIGINAL ARTICLES   

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

Copyright © 2001 EDIZIONI MINERVA MEDICA

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.