Salvage after postoperative thrombosis of the carotid artery.

When dense hemiparesis has developed appropriate to the operated vessel after carotid surgery, the patient has been immediately returned to the operating room for reexploration of the vessel and thrombectomy. Over a 5-year period, we identified four patients who developed dense hemiparesis in the recovery room postoperatively. A fifth patient with a similar problem after carotid subclavian bypass was included for analysis. All patients were found to have thrombosis of the operated vessel. Direct closure had been used after endarterectomy. All vessels were thrombectomized and patched with autogenous vein. Interposition graft was used in the patient who underwent carotid subclavian bypass. There were no deaths, and only one patient did not improve. Our experience encourages us to continue this practice but also suggests that the frequency of this problem may be reduced further by patch angioplasty.