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Inadequate cerebral perfusion is an unlikely cause of perioperative stroke
E G Whitney1, C M Brophy, E M Kahn
1Department of Surgery, Medical College of Georgia, Augusta 30912, USA.
Insights
Hypoperfusion ischemia is a rare cause of stroke during carotid endarterectomy (CEA), even in patients with contralateral carotid artery occlusion. CEA can be safely performed without shunts in these high-risk patients.
Area of Science:
- Neurology
- Vascular Surgery
Background:
- Carotid endarterectomy (CEA) is a procedure to prevent stroke.
- Patients with contralateral carotid artery occlusion are at higher risk for stroke due to potential hypoperfusion ischemia during CEA.
- The use of temporary shunts during CEA in these patients is debated.
Purpose of the Study:
- To determine the incidence and significance of hypoperfusion ischemia as a cause of stroke during CEA.
- To evaluate the safety and efficacy of performing CEA without shunts in patients with contralateral carotid artery occlusion.
Main Methods:
- Retrospective analysis of 128 consecutive CEA procedures.
- Patients included had contralateral carotid artery occlusion.
- Procedures were performed under general anesthesia without temporary shunts.
Main Results:
- Perioperative mortality was 0.8%.
- Permanent neurologic morbidity was 1.6%.
- Transient neurologic morbidity was 3.9%.
- Hypoperfusion ischemia was a rare cause of stroke in this cohort.
Conclusions:
- Hypoperfusion ischemia is an infrequent cause of stroke during CEA, even in patients with contralateral carotid artery occlusion.
- CEA can be safely performed without shunts in patients with contralateral carotid artery occlusion.
- These findings support the safety of CEA without shunts in select high-risk patients.
Abstract:
The purpose of this study was to determine the importance of hypoperfusion ischemia as a cause of stroke during carotid endarterectomy (CEA). A retrospective analysis of 128 consecutive CEA procedures were examined in patients at risk for hypoperfusion ischemia, namely, patients with occlusion of the contralateral carotid artery. All procedures were performed under general anesthesia without the use of a temporary indwelling shunt. Sixty-one percent of patients had cerebrovascular symptoms preoperatively and 39% were asymptomatic. The degree of stenosis of the carotid artery was 80%-99% in 67% (86/128) of patients, 60%-79% in 25% (32/128), 20%-59% in 7% (9/128), and 0-19% in 0.8% (1/128). The perioperative mortality was 0.8% (1/128), the incidence of permanent neurologic morbidity was 1.6% (2/128), and the incidence of transient neurologic morbidity was 3.9% (5/128). In conclusion, these data suggest that hypoperfusion ischemia is a rare cause of stroke during CEA even in patients with occlusion of the contralateral carotid artery and that CEA can be performed safely even in patients with contralateral occlusion without the use of a temporary indwelling shunt.