Prevention of neurologic complications of carotid endarterectomy
M. L. Owens and S. E. Wilson
We studied the neurologic complications after carotid endarterectomy to
develop recommendations for prevention. From 1973 through June 1981, 195
carotid endarterectomies were performed on 184 patients. Carotid
endarterectomy was performed using general anesthesia with routine use of a
Javid shunt. There were no postoperative deaths. Three major, disabling
strokes (1.5%) and four (2%) minor, permanent neurologic deficits occurred.
The neurologic deficits were analyzed according to cause: (1) inadequate
cranial inflow in four patients, (2) fluctuation in blood pressure
requiring treatment in one third (61) of our patients, and (3) embolic
complications, usually a single, transient ischemic episode, in 17 patients
during the first postoperative week. This was not observed in patients
receiving postoperative antiplatelet therapy. Inadequate collateral
cerebral inflow accounts for most permanent postoperative neurologic
deficits. Postoperative hypotension is now more dangerous than
hypertension. Postoperative embolization is largely preventable with
antiplatelet agents.
