Related Experiment Videos
Emergency carotid endarterectomy
Insights
Emergency carotid endarterectomy is effective for stroke prevention. This study shows high rates of improvement in patients with severe stenosis, occlusion, or intraluminal defects, with low mortality.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Neurology
Background:
- Carotid endarterectomy is a surgical procedure to remove plaque from the carotid artery.
- Emergency indications for carotid endarterectomy are less well-defined than elective procedures.
- Understanding outcomes of emergency carotid endarterectomy is crucial for patient management.
Purpose of the Study:
- To evaluate the outcomes of emergency carotid endarterectomy.
- To correlate preoperative angiographic findings and clinical status with postoperative outcomes.
- To discuss the indications for emergency carotid endarterectomy.
Main Methods:
- Retrospective review of 64 emergency carotid endarterectomies performed between July 1976 and December 1985.
- Analysis of patient demographics, angiographic findings, and pre- and postoperative clinical status.
- Categorization of clinical status into five grades: intact, mild, moderate, severe deficit, and death.
Main Results:
- High postoperative improvement rates were observed across different angiographic findings: 93% for severe stenosis, 73% for stenosis with intraluminal defects, 88% for complete occlusion, and 80% for moderate to severe stenosis/ulceration.
- Patients with preoperative intact or mild deficits had a 92% improvement rate with no deaths.
- Patients with moderate and severe deficits showed improvement in 80% and 77% of cases, respectively, with some mortality.
- Overall mortality was low (4 deaths), with causes attributed to cardiac or unrelated disease.
Conclusions:
- Emergency carotid endarterectomy demonstrates favorable outcomes, particularly in patients with severe stenosis or occlusion.
- The procedure appears safe and effective for selected patients presenting with acute neurological deficits.
- Clinical and angiographic assessment is vital for determining eligibility and predicting outcomes in emergency settings.
Abstract:
A retrospective review of carotid endarterectomies performed by the Neurosurgical Service at Massachusetts General Hospital from July, 1976, through December, 1985, disclosed 64 procedures that were performed on an emergency basis. The patients included 40 men and 24 women, with a mean age of 64 years (range 32 to 87 years). Correlation of angiographic findings with outcome revealed that of the 27 patients with severe stenosis, usually with delay in blood flow, 25 (93%) were the same or improved postoperatively; of the 11 patients with stenosis and an intraluminal filling defect (six of whom had an intraluminal clot), eight (73%) were the same or improved after surgery; of the 16 patients with complete occlusion, 14 (88%) were the same or improved (backflow was established in all cases); and of the 10 patients with moderate to severe stenosis and/or severe ulceration (including three with transient ischemic attacks who were receiving heparin), eight (80%) were the same or improved. Pre- and postoperative clinical status were graded into five categories: intact; mild deficit; moderate deficit (significant impairment but able to perform activities of daily living); severe deficit (requiring assistance for daily activities); and death. Of the 36 patients who preoperatively were intact or had mild deficits, 33 (92%) were the same or improved postoperatively, three were worse, and there were no deaths. Among 15 patients presenting with moderate deficits, 12 (80%) were the same or improved, two were worse, and one died. Of the 13 patients with severe deficits, 10 (77%) were the same or improved and three died. Two patients with sudden severe deficits associated with loss of contralateral bruit were operated on without angiography and were intact postoperatively. Of the four deaths in the total series, two were attributed to cardiac causes and two to unrelated disease processes. The indications for emergency carotid endarterectomy are discussed.