Cerebral protection in carotid surgery
A. M. Imparato, A. Ramirez, T. Riles and R. Mintzer
We performed 956 carotid endarterectomies in 661 conscious patients who
were under cervical block anesthesia and in whom the stroke rate was 2.5%.
They were analyzed to determine the mechanisms of strokes and the risk
factor for perioperative stroke. Twenty-three patients with perioperative
strokes, regardless of severity, were analyzed as to the mechanism of
cause. One half were due to technical problems, one quarter to
intraoperative embolization, one sixth to intracerebral hemorrhage, and the
remainder were not directly related to the operative procedures.
Perioperative stroke rate varied by group from 0.6% to 28.4%, highest when
the contralateral carotid was occluded, where there was a preoperative
persistent neurologic deficit, and when the patient failed to tolerate
carotid clamping. Regional block monitoring was accurate and no stroke
could be ascribed to anesthetic technique. Standard reporting techniques
should be used in classifying patients into appropriate risk groups to
permit meaningful comparisons among groups using different techniques for
cerebral protection.
