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

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.