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Carotid endarterectomy: outcome of "old-fashioned" approach
1Division of Cardiothoracic Surgery, University of Kentucky, Lexington, Kentucky 40502, USA. jsoldh2@email.uky.edu
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Carotid endarterectomy with selective shunting and primary closure is a safe procedure. This study found low rates of stroke, death, and other complications within 30 days post-surgery.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid endarterectomy (CEA) is a procedure to remove plaque from carotid arteries.
- Optimizing CEA techniques is crucial for reducing postoperative complications.
- Selective shunting and primary closure are specific surgical approaches in CEA.
Purpose of the Study:
- To evaluate the 30-day postoperative incidence of death, myocardial infarction, stroke, wound complications, and cranial nerve damage after CEA.
- To assess the impact of induced hypertension, selective shunting, and primary closure on morbidity and mortality in CEA patients.
Main Methods:
- Retrospective analysis of 239 CEA surgeries performed on 206 patients between January 2002 and August 2009.
- Data collected included patient demographics, comorbidities, presenting symptoms, and surgical details.
- Postoperative complications were tracked for 30 days following the procedure.
Main Results:
- The study involved 239 CEAs in 206 patients (55% male, average age 67).
- Low complication rates were observed: stroke (1.3%), transient ischemic attack (TIA) (1.7%), bleeding (2.1%), superficial wound infection (0.8%), myocardial infarction (0.4%).
- There were no cranial nerve injuries or hospital deaths; one death (0.4%) occurred at home from an unknown cause.
Conclusions:
- Carotid endarterectomy utilizing induced hypertension, selective shunting, and primary closure is a safe and effective stroke prevention strategy.
- The findings support the use of these techniques to minimize adverse outcomes after CEA.
- This approach demonstrates a favorable safety profile for patients undergoing CEA.
Abstract:
The purpose of this study is to assess the 30-day postoperative incidence of death, myocardial infarction, stroke, wound complication, and cranial nerve damage after carotid endarterectomy using induced hypertension (systolic pressure > or = 160 mmHg), selective shunting, and primary closure. We retrospectively analyzed the records of 206 patients who underwent a total of 239 carotid endarterectomy surgeries between January 2002 and August 2009 to identify the impact of selective shunting and primary closure on morbidity and mortality. Two hundred thirty-nine surgeries were performed on 206 patients. The study population was 55% men and 45% women with average age of 67 years (range 33-85 years). Of these patients, 181 had hypertension (88%), 82 had diabetes (40%), 73 had peripheral vascular disease (35%), 107 had coronary artery disease (52%), 142 had tobacco abuse (69%), and 146 had dyslipidemia (71%). Twenty-six patients (13%) presented with history of stroke, 77 (37%) with transient ischemic attack (TIA), 14 (7%) with amaurosis fugax, and 108 (52%) were asymptomatic. The average internal carotid stenosis was 74% as indicated by duplex, computed tomography, magnetic resonance imaging, or angiogram. Of the 239 surgeries, 3 (1%) required patch closure, and 7 (3%) required shunt. Thirty-day postoperative complication rates are as follows: stroke, 3 (1.3%); TIA, 4 (1.7%); bleeding, 5 (2.1%); superficial wound infection, 2 (0.8%); heart attack, 1 (0.4%); cranial nerve injury, 0; and hospital death, 0. One patient (0.4%) died at home from an unknown cause. In conclusion, carotid endarterectomy with selective shunting and primary closure is a safe and effective surgical means of preventing stroke.
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