Management of early neurologic deficits after carotid thrombendarterectomy

A neurologic deficit appearing during the early postoperative period after an interval following an otherwise successful carotid endarterectomy may be caused by thrombotic material formed in the carotid bifurcation. Our experience of immediate reoperation on eight such cases during a period of 2 years is reported in this paper. Thrombotic occlusion was found at reoperation in seven cases and a non-occluding thrombus in one case. Four of the patients were fully restored immediately after reoperation. In two cases good recovery but with some persisting symptoms was seen. One patient became hemiparetic with moderate restitution and one suffered a dense hemiplegia. We recommend an aggressive approach with immediate reoperation in these cases.