Related Experiment Videos
Perioperative stroke during carotid endarterectomy: the value of intraoperative angiography
Insights
Intraoperative arteriography significantly reduced stroke and mortality after carotid endarterectomy by identifying and correcting internal carotid artery defects. Ultrasound may offer future assessment benefits.
Area of Science:
- Vascular Surgery
- Neurology
- Radiology
Background:
- Stroke is a significant risk following carotid endarterectomy.
- Common causes include occlusion, embolization, and intimal flap elevation.
Purpose of the Study:
- To evaluate the impact of intraoperative arteriography on stroke and mortality rates after carotid endarterectomy.
- To assess the effectiveness of intraoperative arteriography in identifying and managing post-surgical carotid artery defects.
Main Methods:
- Retrospective analysis of carotid endarterectomy outcomes.
- Comparison of outcomes between patients with and without intraoperative arteriography.
- Identification and revision of internal carotid artery defects based on arteriogram findings.
Main Results:
- Carotid endarterectomy without intraoperative arteriography: 4.8% mortality, 6.8% stroke.
- Carotid endarterectomy with intraoperative arteriography: 1.5% mortality, 3.6% stroke.
- Revision of 12 internal carotid artery defects identified via arteriography contributed to improved outcomes.
Conclusions:
- Intraoperative arteriography is associated with reduced mortality and stroke incidence after carotid endarterectomy.
- The technique aids in identifying and correcting post-surgical defects, improving patient outcomes.
- Ultrasound may be a valuable future tool for assessing technical results in carotid endarterectomy.
Abstract:
Stroke following carotid endarterectomy is ordinarily attributed to carotid occlusion without adequate shunting, to embolization of air, atheroma, or thrombus, or to the elevation of an intimal flap. In 146 carotid endarterectomies in which intraoperative arteriography was not used, we observed a mortality of 4.8% and an incidence of perioperative stroke of 6.8%. In a subsequent group of patients in which 137 endarterectomies were performed with 107 intraoperative arteriograms to assess the immediate post-surgical results, there was a mortality of 1.5% and an incidence of perioperative stroke of 3.6%. We attribute this difference, in part, to the revision of 12 internal carotid artery defects observed on the arteriograms. Intraoperative arteriography was easy to perform and without complication; however, we recommend that consideration be given to ultrasound as a potentially useful way in the future of assessing technical results.