Site and pathogenesis of infarcts associated with carotid endarterectomy

• Published in: Stroke (1970) Vol. 20; no. 3; pp. 324 - 328
• Main Authors: KRUL, J. M. J, VAN GIJN, J, ACKERSTAFF, R. G. A, EIKELBOOM, B. C, THEODORIDES, T, VERMEULEN, F. E. E
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.03.1989
• Subjects: Biological and medical sciences; Brain - diagnostic imaging; Brain - physiopathology; Carotid Arteries - surgery; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - etiology; Cerebral Infarction - physiopathology; Electroencephalography; Endarterectomy - adverse effects; Humans; Medical sciences; Neurosurgery; Skull, brain, vascular surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tomography, X-Ray Computed; Human; Cerebral infarction; Nervous system diseases; Radiodiagnosis; Etiopathogenesis; Intraoperative; Electroencephalography; Electrodiagnosis; Carotid; Surgery; Topography; Complication; Computerized axial tomography; Endarteriectomy; Monitoring
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.20.3.324

We analyzed perioperative strokes in 658 carotid endarterectomies with the purpose of explaining the pathogenesis from the morphologic aspect of the infarct on cerebral computed tomograms. All endarterectomies were performed with continuous electroencephalographic monitoring. Of the 42 ischemic strokes (6.4% of all endarterectomies), 34 could be studied. Seven infarcts were hemodynamically induced (five watershed infarcts, two patients with bilateral ischemia); all seven occurred during surgery. Twenty-three of the remaining 27 infarcts were within the territory of the middle cerebral artery (20) or anterior cerebral artery (three) and were probably of thromboembolic origin; 13 of these 23 occurred during surgery (57%). If intraoperative stroke was heralded by permanent electroencephalographic changes, these were not related to the moment of cross-clamping. In four patients the computed tomogram was normal. We believe these facts favor the hypothesis that thromboembolism is the most important factor in the pathogenesis of perioperative stroke associated with carotid endarterectomy under conditions of optimal cerebral monitoring.