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Symptomatic internal carotid thrombosis after carotid endarterectomy
T A Painter1, N R Hertzer, P J O'Hara
1Department of Vascular Surgery, Cleveland Clinic Foundation, OH 44106.
Insights
Early symptomatic thrombosis of the internal carotid artery (ICA) after carotid endarterectomy is rare but serious. Urgent reoperation offers significant recovery for most patients, making prompt surgical intervention crucial.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiovascular Medicine
Background:
- Carotid endarterectomy is a common procedure to prevent stroke.
- Early thrombosis of the internal carotid artery (ICA) is a rare but severe complication following this surgery.
Purpose of the Study:
- To evaluate the incidence, clinical presentation, and outcomes of early symptomatic internal carotid artery (ICA) thrombosis after carotid endarterectomy.
- To assess the effectiveness of urgent reoperation for this complication.
Main Methods:
- Retrospective review of patients undergoing carotid endarterectomy between 1977 and 1984.
- Analysis of cases with early, symptomatic ICA thrombosis requiring urgent reoperation.
- Review of surgical techniques and patient outcomes.
Main Results:
- 11 out of 2651 patients (0.4%) experienced early symptomatic ICA thrombosis.
- Neurologic deficits typically occurred within 24 hours post-surgery after a lucid interval.
- Eight of 11 patients (73%) recovered substantial neurologic function after reoperation, with six achieving near-complete symptom resolution.
Conclusions:
- Early symptomatic ICA thrombosis is a rare but significant complication of carotid endarterectomy.
- Prompt surgical reoperation, including thrombectomy and angioplasty, is associated with favorable outcomes.
- Surgical intervention appears to be the preferred management for this catastrophic complication.
Abstract:
During a study period from 1977 through 1984, 11 (0.4%) of 2651 patients who had undergone carotid endarterectomy at The Cleveland Clinic had early, symptomatic thrombosis of the internal carotid artery (ICA) and underwent urgent reoperations. With only two exceptions, neurologic deficits occurred after lucid intervals when the patients had recovered from general anesthesia and were discovered within the first 8 hours in three patients, within 8 to 24 hours in five patients, and on the second postoperative day in one patient. Surgical management consisted of thrombectomy alone in two patients, thrombectomy and vein patch angioplasty in eight patients, and thrombectomy of the external carotid artery with ligation of the ICA in a single patient in whom retrograde ICA flow could not be reestablished. Eight (73%) of the 11 patients recovered substantial neurologic function after reoperations, six of whom had complete or nearly complete resolution of their symptoms. One patient (9%) sustained a fatal hemorrhagic cerebral infarction. In a collected series of 41 patients from this study and other reports, prompt surgical treatment of thrombosis occurring after carotid endarterectomy was associated with clinical improvement in 61% of patients and appears to be the preferred approach to this catastrophic complication.