Management of immediate occlusion after carotid-reconstruction

In spite of clear cut indications for surgery and the use of standardized techniques, operative failures are still to be found in carotid surgery, that is, the occurrence or aggravation of neurologic symptoms in connection with surgical reconstruction. These can present when the patient regains consciousness or develop from hours to days postoperatively. Within 3 1/2 years 93 carotid artery operations were performed in 79 patients. The purpose of our presentation is to describe 5 patients who developed neurologic deficits after a successful carotid reconstructive procedure within 18 hours to 10 days postoperatively. These patients were immediately returned to the operation room and reoperated upon. In 4 of 5 cases we achieved a complete recovery. Even though our patient content is small we want to point out that in patients who develop neurological deficits postoperatively after successful surgical procedures an immediate reoperation is mandatory, and may be completely successful. In almost all patients with recurrent neurological deficits after primarily successful reconstructions we carried out control angiograms. We want to emphasize that these procedures are not obligatory since the cause for reoperation is nearly always technical and will require operative revision.