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Salvage after postoperative thrombosis of the carotid artery
1Greater Victoria Hospital Society, British Columbia, Canada.
Insights
Reoperation for carotid artery thrombosis after surgery is effective, with most patients recovering well. Prompt surgical intervention for post-operative hemiparesis can prevent permanent deficits.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Background:
- Postoperative dense hemiparesis following carotid surgery indicates potential carotid artery thrombosis.
- Prompt reoperation and thrombectomy are crucial for managing this critical complication.
Purpose of the Study:
- To evaluate the efficacy of immediate reoperation and thrombectomy for patients experiencing dense hemiparesis after carotid surgery.
- To analyze outcomes and identify potential strategies for reducing the incidence of this complication.
Main Methods:
- Retrospective analysis of five patients who developed dense hemiparesis post-carotid surgery or carotid subclavian bypass.
- Surgical reexploration, thrombectomy, and vessel reconstruction (vein patch or interposition graft).
Main Results:
- All five patients presented with thrombosis of the operated vessel.
- Successful thrombectomy and reconstruction were performed in all cases.
- No deaths occurred; one patient did not experience improvement in hemiparesis.
Conclusions:
- Reoperation with thrombectomy is an effective treatment for carotid artery thrombosis causing postoperative hemiparesis.
- Patch angioplasty may further reduce the frequency of this complication.
Abstract:
When dense hemiparesis has developed appropriate to the operated vessel after carotid surgery, the patient has been immediately returned to the operating room for reexploration of the vessel and thrombectomy. Over a 5-year period, we identified four patients who developed dense hemiparesis in the recovery room postoperatively. A fifth patient with a similar problem after carotid subclavian bypass was included for analysis. All patients were found to have thrombosis of the operated vessel. Direct closure had been used after endarterectomy. All vessels were thrombectomized and patched with autogenous vein. Interposition graft was used in the patient who underwent carotid subclavian bypass. There were no deaths, and only one patient did not improve. Our experience encourages us to continue this practice but also suggests that the frequency of this problem may be reduced further by patch angioplasty.