Management of acute postoperative occlusion of an internal carotid artery

Complete occlusion of an endarterectomized internal carotid artery in the early postoperative period is uncommon. In a series of 325 consecutive carotid endarterectomies, the authors recognized this complication on five occasions. In each instance, early reoperation resulted in neurologic improvement of the patient. Awareness of the condition is important in making the diagnosis; in two patients the deficit was mild, despite complete occlusion of the endarterectomized artery. Therefore, the authors believe that any neurologic deficit early after endarterectomy of an internal carotid artery should be aggressively investigated and patency of the affected segment re-established.