Surgical strategy for patients undergoing carotid endarterectomy

Carotid endarterectomy (CEA) is a surgical intervention that aims to reduce neurological symptoms in carotid atherosclerosis and prevent brain damage and subsequent permanent neurological deficit.

To study the major risk factors, surgical techniques, applied diagnostic methods and perioperative complications occurred in patients undergoing CEA.

496 surgical interventions on the occasion of stenosis and/or occlusions of the carotid arteries were performed for the period 1987-2009 at the department of Vascular Surgery and Angiology of "St. Ekaterina"- University Hospital - Sofia. All patients were operated using standard access under general or local anaesthesia. During surgeries, the evaluation of cerebral hemodynamics and function was performed by transcranial Doppler Ultrasound (TCD) and cerebral oximetry (CO). Carotid shunting was selectively applied in cases of deterioration of the values of CO and TCD during cross clamping of the carotid arteries.

With the highest relative share among cerebrovascular complications was stroke with 2.7% share in the group of asymptomatic patients and 1.7%--in the symptomatic group. When considering the other types of complications with the largest relative share were cardiac complications in both groups of patients--hemodynamic disorders and myocardial infarction.

Low values of postoperative mortality and stroke after CEA in our study are comparable with other leading centers, proving that CEA is safe and effective surgical procedure for stroke prevention in both symptomatic and asymptomatic patients. Accurate perioperative diagnostic allows a good approach for choosing the correct surgical strategy.