Reexploration for thrombosis in carotid endarterectomy

We reviewed the records of patients undergoing carotid endarterectomy and manifesting either postoperative stroke or thrombosis by oculopneumoplethysmography (OPG-Gee) to analyze the etiology of stroke and to determine the indications for reexploration. Of 900 consecutive elective endarterectomies performed during an 8-year period, 41 patients experienced a perioperative stroke, carotid thrombosis, or both. These patients were subdivided into three groups: group 1, 22 patients with perioperative stroke and carotid thrombosis; group 2, six patients with carotid thrombosis but without symptoms; and group 3, 13 patients with postoperative stroke but no thrombosis. In group 1, 17 patients were reexplored (group 1a), and five were observed without reexploration (group 1b). In group 2, three of the patients were reexplored (group 2a), and the remaining three were observed (group 2b). None of the group 3 patients were reexplored. In group 1a, four (23%) patients awoke from anesthesia with neurological deficits, whereas in group 3, nine (69%) patients awoke with such deficits. Follow-up at 30 days revealed that 76% of group 1a patients demonstrated improvement in symptoms, whereas similar results were seen in only 20% of group 1b patients and 23% of group 3 patients. These trends were maintained throughout the follow-up period of 1-5 years. Those patients who were asymptomatic, group 2, with thrombosis were more likely to have been operated on for asymptomatic carotid stenosis. with thrombosis were more likely to have been operated on for asymptomatic carotid stenosis. Thrombosis was the most common cause of postoperative stroke (63%) in patients after carotid endarterectomy.(ABSTRACT TRUNCATED AT 250 WORDS)