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Seizures following carotid endarterectomy in patients with severely compromised cerebral circulation
T G Nielsen1, H Sillesen, T V Schroeder
1Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Denmark.
Insights
Postoperative seizures after carotid endarterectomy can occur in patients with severely reduced cerebral circulation. Careful patient selection and meticulous blood pressure control are crucial to prevent these neurological complications.
Area of Science:
- Vascular Surgery
- Neurology
- Cerebrovascular Disease
Background:
- Carotid endarterectomy is a procedure to remove plaque from carotid arteries.
- Severely compromised cerebral circulation poses risks for neurological complications post-surgery.
Purpose of the Study:
- To determine the incidence of postoperative neurological complications after carotid endarterectomy.
- To investigate the link between cerebral circulation compromise and neurological events.
Main Methods:
- Prospective open clinical study involving 151 patients undergoing 153 carotid endarterectomies.
- Intraoperative measurement of perfusion pressure to assess hemodynamic impairment.
- Analysis of the cerebral perfusion pressure index (ICA/CCA pressure ratio).
Main Results:
- 47% of patients with 70-99% stenosis had significantly reduced cerebral perfusion pressure index compared to 6% with 30-69% stenosis.
- Five hemodynamically compromised patients developed seizures attributed to cerebral hyperperfusion 5-7 days post-surgery.
- Seizures were associated with headache, focal neurological deficits, and hypertension; symptoms resolved within 2 weeks without cerebral hemorrhage.
Conclusions:
- Seizures post-carotid endarterectomy for high-grade stenosis causing severe pressure reduction may be more frequent than previously thought.
- Identifying at-risk patients is essential.
- Meticulous postoperative blood pressure control is critical.
Objectives:
To determine the incidence of postoperative neurological complications following carotid endarterectomy in patients with severely compromised cerebral circulation.
Design:
Prospective open clinical study.
Setting:
Department of Vascular Surgery, University Hospital.
Materials And Methods:
We determined the incidence of postendarterectomy seizures related to haemodynamic impairment in terms of intraoperatively measured perfusion pressure in 151 patients undergoing 153 carotid endarterectomies.
Main Results:
Cerebral perfusion pressure index (ICA/CCA pressure ratio) was significantly reduced (25% or more) in 47% (55/118) of patients with 70-99% stenosis compared to 6% (2/35) of patients with 30-69% stenosis (p < 0.00005). Among the 57 haemodynamically compromised patients five developed seizures considered due to cerebral hyperperfusion five to seven days after surgery. The seizures were associated with headache in two, focal neurological deficits in four and hypertensive episodes in all cases. The symptoms remitted within 2 weeks and no patients suffered cerebral haemorrhage.
Conclusions:
Seizures following correction of high grade stenoses causing severe pressure reduction may be more common than previously assumed. Patients at risk should be identified and postoperative blood pressure controlled meticulously.