Carotid artery spasm. A cause of postendarterectomy thrombosis?
C. R. Lye, I. M. Morrow and A. R. Downs
Carotid endarterectomy is generally regarded as a durable repair, with a
low incidence of postoperative thrombosis. However, unexpected,
inexplicable occlusions and pressure-flow aberrations have been reported to
occur during the period immediately after operation period. We studied 245
operative angiograms obtained during a series of 335 carotid
endarterectomies. Among the various defects noted were 24 instances of mild
to severe spasm of the middle and distal extracranial carotid artery. This
spasm was remote from the endarterectomy site and often was entirely beyond
the field of operative exposure. Early and late postoperative angiograms
demonstrated that this may be a transient phenomenon, and repeated
intraoperative films documented that spasm may progress without further
direct instrumentation of the involved segment. The patient who
demonstrated the most severe spasm later suffered immediate postoperative
occlusion and stroke despite a technically satisfactory repair.
