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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
09:21

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

Published on: January 18, 2018

Early acute hemispheric stroke after carotid endarterectomy. Pathogenesis and management

Giovanni Pappadà1, Francesco Vergani, Michele Parolin

  • 1Neurosurgery Department, University of Milano-Bicocca, at San Gerardo Hospital, 20052 Monza, Milan, Italy. giovanni.pappada@fastwebnet.it

Acta Neurochirurgica
|October 21, 2009
PubMed

Insights

A major stroke after carotid endarterectomy (CEA) is often due to acute internal carotid artery (ICA) occlusion. Reopening the ICA can lead to good outcomes if the artery is successfully reopened and intracranial vessels remain patent.

Area of Science:

  • Vascular Surgery
  • Neurology
  • Cerebrovascular Disease

Background:

  • Stroke is a significant complication following carotid endarterectomy (CEA).
  • Management strategies for post-CEA stroke require further definition.
  • This study aims to establish a treatment algorithm for perioperative stroke after CEA.

Purpose of the Study:

  • To review a series of patients experiencing stroke after CEA.
  • To define an effective treatment algorithm for managing major stroke post-CEA.
  • To analyze the outcomes of interventions for acute internal carotid artery occlusion.

Main Methods:

  • A consecutive series of 413 CEAs in 390 patients was analyzed.
  • Patients experiencing new or worsening ischemic hemispheric deficits within 72 hours post-surgery were included.
  • Operations were performed under general anesthesia with EEG monitoring; shunting was based on EEG changes.

Main Results:

  • Sixteen patients (3.9%) experienced perioperative stroke, with nine (2.2%) having major strokes.
  • Acute internal carotid artery (ICA) occlusion was the primary cause in most major stroke cases.
  • Seven of nine patients with major stroke underwent reoperation; ICA reopening was successful in six, with three achieving good outcomes.

Conclusions:

  • Major stroke post-CEA is frequently caused by acute ICA occlusion, potentially with intracranial emboli.
  • Successful reopening of the ICA is crucial for favorable outcomes.
  • A planned management algorithm for perioperative stroke after CEA is proposed based on these findings.
Abstract

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