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Management options for post carotid endarterectomy stroke
A F Aburahma1, P A Robinson, Y S Short
1Department of Surgery, Robert C. Byrd Health Sciences Center of West Virginia University, Charleston, USA.
Insights
Carotid artery thrombosis is a common cause of stroke after carotid endarterectomy. Early detection with OPG/Gee and prompt exploration improve patient outcomes.
Area of Science:
- Vascular Surgery
- Neurology
- Diagnostic Imaging
Background:
- Management of acute carotid artery thrombosis post-endarterectomy remains controversial.
- This study retrospectively analyzes stroke etiology and management strategies following carotid endarterectomy.
Purpose of the Study:
- To review the causes of stroke after carotid endarterectomy.
- To analyze the effectiveness of different management options for post-endarterectomy stroke.
- To evaluate the diagnostic accuracy of Oculopneumoplethysmography (OPG/Gee) in detecting carotid thrombosis.
Main Methods:
- Retrospective review of patients experiencing stroke post-carotid endarterectomy.
- Diagnosis utilized Oculopneumoplethysmography (OPG/Gee), duplex ultrasound, CT scanning, and carotid exploration.
- Management strategies included selective exploration, mandatory exploration, and medical treatment.
Main Results:
- Carotid thrombosis was identified as the cause of stroke in 59% of patients.
- OPG/Gee demonstrated 95% accuracy in detecting postoperative thrombosis (100% sensitivity, 89% specificity).
- Thrombectomy and patch angioplasty improved neurological status in 7/12 patients, especially when performed within two hours of stroke onset.
Conclusions:
- Carotid artery thrombosis is the primary cause of stroke following carotid endarterectomy.
- OPG/Gee is a reliable diagnostic tool for identifying carotid thrombosis.
- Prompt carotid exploration and thrombectomy for Grade I or II strokes significantly improve recovery.
Background:
Management of acute thrombosis of the carotid artery has been controversial. This retrospective study reviews the etiology and analyzes the management options of post carotid endarterectomy stroke.
Methods:
Diagnosis was made using oculopneumop-lethysmography (OPG/Gee), duplex ultrasound, computed tomography (CT) scanning, and carotid exploration.
Results:
The cause of stroke was identified as carotid thrombosis in 19/32 patients (59%) and non-carotid thrombosis in 13. Management options included nine patients who underwent selective carotid exploration and all had a thrombosed carotid; mandatory exploration-six were explored and three had a thrombosed carotid artery; and 17 patients had no exploration (medical treatment). Fourteen patients had a positive OPG, 13 were confirmed to have carotid thrombosis. Eight patients had a negative OPG and all were confirmed. The OPG had an overall accuracy of 95% in detecting postoperative thrombosis (89% specificity and 100% sensitivity). Patients with thrombosed carotids and patients with positive OPGs had more severe neurological deficits than those with non-thrombosed carotids. The final neurological status of the 12 patients with carotid thrombosis who underwent thrombectomy and patch angioplasty was improved (7/12) in contrast to the seven patients who did not undergo a thrombectomy (1/7). Seven of nine patients had a complete or good recovery when thrombectomy was done within two hours of the stroke in contrast to 0/3 after two hours. Seven of ten patients with Grade II stroke (moderate) had a good recovery after carotid exploration and thrombectomy in contrast to 0/2 for Grade III (severe) stroke.
Conclusions:
Carotid artery thrombosis, the most common cause of post carotid endarterectomy stroke, can be detected by OPG/Gee. Immediate carotid exploration for patients with Grade I or II strokes, when thrombosis is demonstrated, can improve the results of carotid endarterectomy.