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William M. Novick, MD; John J. Millili, MD; Paul Nemir, Jr, MD

Arch Surg. 1985;120(8):922-925.

Abstract
• We reviewed 326 carotid endarterectomies performed from 1960 through 1981 and encountered five instances of acute postoperative thrombosis. Clinical decompensation occurs with the acute onset of severe neurologic deficits, most characteristically dense hemiplegias contralateral to the side that has been operated on. These deficits developed between two and 72 hours postoperatively. Prompt reoperation with thrombectomy and reestablishment of carotid flow within two hours from the onset of the neurologic deficit was performed on four patients with complete resolution of the deficits in three patients. The fourth patient recovered from a severe hemiplegia but retained a slight residual weakness of the hand. The one patient whose condition did not improve underwent thrombectomy more than 24 hours after the onset of her deficit. Time-consuming diagnostic procedures are not warranted as the success of reoperation depends on rapid re-establishment of cerebral flow.

(Arch Surg 1985;120:922-925)

Author Affiliations
From the Department of Surgery, School of Medicine, University of Pennsylvania and The Graduate Hospital, Philadelphia.

Footnotes
Accepted for publication Oct 18, 1984.

Reprint requests to Department of Surgery, The Graduate Hospital, One Graduate Plaza, Suite 1100, Philadelphia, PA 19146 (Dr Novick).

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