Our experience with Carotid Endarterectomy

Abstract

Introduction

Stroke is the second most common cause of cardiovascular mortality. Atherosclerosis is the most common cause of carotid artery stenosis. The most common site is carotid bifurcation where the carotid baroreceptors exist and internal carotid artery. The primary objective of carotid surgery is to protect the brain from an ischemic damage. In this study, we evaluated early and mid term result of 24 patients who had undergone unilateral carotid endarterectomy surgery.

Patients, materials and methods

A total of  24 patients (17 males, 7 females; mean age 68.62 years; ranges from 55 to 91 years) who underwent CEA operations between January 2015 and january 2017 were retrospectively analyzed. Postoperative complications (neurological and non-neurological) and mortality were the primary outcome points in the study. Clinical findings and risk factors were evaluated.

Results

Among the seven of the 24 NIRS monitored patients (5 males, 2 females; mean age 65.8 years; range 60 to 75 years), a significant decrease in cerebral SO2 was observed during clamping of the common carotid artery. For this reason we decided to use intracarotid shunt. We observed that the cerebral oximetry values were increased after the use of a shunt in these seven cases.

 

Discussion

NIRS monitoring is a precious tool which provides vital information and is used to determine whether a shunt is needed during CEA surgery. The present study showed that carotid endarterectomy under general anesthesia accompanying NIRS, measurement of the stump pressure and usage of dacron patch material can be performed with acceptable mortality and morbidity.

Keywords

• Carotid arter,stenosis,endarterectomy

References

1. - Aksun M, Girgin S, Kuru V, Şencan A,Yılık L, Aran G et al. Cerebral oximetry monitoring method for the evaluation of the need of shunt placement during carotid endarterectomy. Turkish J Thorac Cardiovasc Surg 2013;21(4):1152-1155.
2. - Ballotta E, Da Giau G, Baracchini C. Carotid endarterectomy contralateral to carotid artery occlusion: analysis from a randomized study. Langenbecks Arch Surg 2002;387:216-21.
3. - Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, et al. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS guideline on the management of patients with extracranial carotid and vertebral artery disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery. J Am Coll Cardiol 2011;57:16-94.
4. - De Bakey ME. Successfull carotid endarterectomy for cerebrovascular insufficiency: Nineteen-year follow-up. JAMA 1975;233:1083-5.
5. - Grego F, Antonello M, Lepidi S, Zaramella M, Galzignan E, Menegolo M, et al. Is contralateral carotid artery occlusion a risk factor for carotid endarterectomy? Ann Vasc Surg 2005;19:882-9.
6. - Hidiroglu M, Cetin L, Kunt A, Karakisi O, Kucuker A, Sener O. Early results of carotid endarterectomy for carotid artery diseases. Turkish J Thorac Cardiovasc Surg 2010;18(3):190-195.
7. - Liapis CD, Bell PR, Mikhailidis D, Sivenius J, Nicolaides A, Fernandes e Fernandes J, et al. ESVS guidelines. Invasive treatment for carotid stenosis: indications, techniques. Eur Vasc Endovasc Surg 2009;37(4 Suppl):1-19.
8. - North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. Engl J Med 1991;325:445-53.

9. - Ozdemir N, Nuser CJ, Gabel W. Bilateral karotis darlıklarında cerrahi tedavi ve sonuçları. Turkish J Thorac Cardiovasc Surg 1995;3:211-5.
10. - Yildirim T, Akgun S, Sur H, Kinikoglu H, Bilgin F, Arsan S. Short-term results of simultaneous carotid endarterectomy and myocardial revascularization. Turkish J Thorac Cardiovasc Surg 2004;12:156-160.