Related Experiment Videos
[Results and role of carotid endarterectomy]
1Neurochirurgische Klinik, Inselspital, Universität Bern. alain.barth@insel.ch
Insights
Carotid endarterectomy is a safe and effective procedure for preventing strokes in patients with carotid artery stenosis. This study highlights low complication rates achieved through advanced monitoring techniques during surgery.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Context:
- Carotid endarterectomy is a cornerstone for stroke prevention in high-grade carotid artery stenosis.
- Quality control of surgical outcomes is crucial for patient safety and efficacy.
- Established indications are based on large-scale randomized trials.
Purpose:
- To analyze the surgical outcomes of 272 carotid endarterectomies.
- To evaluate the prevention of intraoperative brain ischemia.
- To assess the safety and efficacy of the procedure.
Summary:
- The study reviewed 272 carotid endarterectomies in 260 patients, focusing on preventing intraoperative brain ischemia.
- Patients underwent general anesthesia with moderate hypothermia, EEG monitoring, and Transcranial Doppler sonography.
- The procedure demonstrated a low complication rate, with 91.5% of patients having an uneventful postoperative course and a combined major stroke and death rate of 2.2%.
Impact:
- Confirms carotid endarterectomy as a safe and effective treatment for atherosclerotic carotid stenosis.
- Demonstrates that non-invasive diagnostics and intraoperative monitoring minimize complication rates.
- Provides a benchmark for comparing surgical outcomes with emerging endovascular therapies.
Background:
The indications for carotid endarterectomy have been defined on the basis of several large prospective randomised trials. Today this operation is widely performed as primary and secondary stroke prevention in patients with high grade carotid artery stenosis. Permanent quality control of the surgical results is mandatory to ensure optimal stroke prevention and further reduce perioperative complications.
Methods:
In this retrospective study we analyse the surgical results of 272 consecutive carotid endarterectomies performed in 260 patients with special emphasis on the prevention of intraoperative brain ischaemia. Patients were operated on in general anaesthesia and moderate hypothermia. Before clamping the arteries at the neck, a fast-acting barbiturate or propofol was administered intravenously to obtain burst suppression on the EEG. Transcranial Doppler sonography allowed continuous intraoperative monitoring of brain perfusion and detection of emboli. Intraoperative shunting was performed only when the collateral circulation was insufficient.
Results:
The postoperative course was uneventful in 249 endarterectomies (91.5%). The internal carotid artery was sonographically recanalised at hospital discharge and at 6-week follow-up in all 249 cases. Ischaemic cerebral complications were observed in 7 patients (2.6%): minor reversible brain ischaemia in 4 (1.5%), and major brain ischaemia with infarction in 3 (1.1%). Three patients died in the perioperative period, representing a mortality rate of 1.1% in this series. The overall combined stroke and death rate was 3.7%. The combined major stroke and death rate was 2.2%. Various non cerebral complications occurred in 13 patients (4.8%).
Conclusions:
These results confirm that endarterectomy is a safe and efficient treatment for atherosclerotic carotid stenosis at the neck. Very low complication rates can be attained by non-invasive diagnostic methods combined with intraoperative monitoring of cerebral blood flow velocity. New upcoming endovascular therapies such as percutaneous angioplasty and stenting need to be compared with these current surgical results with regard not only to perioperative morbidity and mortality but also patency rate, restenosis, and intracerebral blood flow restoration.