Emergency Carotid Thromboendarterectomy: Safe and Effective

• Published in: World journal of surgery Vol. 23; no. 11; pp. 1163 - 1167
• Main Authors: Schneider, Christina, Johansen, Kaj, Königstein, Ralf, Metzner, Christoph, Oettinger, Wolfgang
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.11.1999; Springer; Springer Nature B.V
• Subjects: Aged; Anticoagulants - therapeutic use; Biological and medical sciences; Blood Vessel Prosthesis Implantation; Blood-Brain Barrier; Carotid Artery Stenosis; Carotid Endarterectomy; Carotid Stenosis; Cerebral Angiography; Clinical Protocols; Coma - physiopathology; Compute Tomographic; Elective Surgical Procedures; Emergencies; Endarterectomy, Carotid - adverse effects; Endarterectomy, Carotid - methods; Female; Heparin - therapeutic use; Humans; Ischemic Attack, Transient - diagnostic imaging; Ischemic Attack, Transient - surgery; Male; Medical sciences; Middle Aged; Paresis - etiology; Polyethylene Terephthalates; Retrospective Studies; Safety; Stroke - diagnostic imaging; Stroke - surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Suture Techniques; TEAC; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography, Doppler; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels; Human; Evaluation; Nervous system diseases; Stroke; Treatment efficiency; Cardiovascular disease; Cerebral disorder; Result; Vascular disease; Ischemia; Surgery; Carotid; Central nervous system disease; Safety; Technique; Emergency; Endarteriectomy; Cerebrovascular disease; Comparative study
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s002689900640

. Whether to perform emergency carotid thromboendarterectomy (CTEA) in the presence of crescendo transient ischemic attacks or stroke‐in‐evolution is controversial, with the operative mortality in some reports exceeding 20% and improvement in neurologic deficit of less than 40% in others. Our anecdotal experience with emergency CTEA for acute, persistent, or crescendo neurologic deficit had been strikingly better than published reports. Accordingly, we carried out a restrospective comparison of 43 such patients undergoing emergency CTEA with 237 patients concurrently undergoing elective CTEA for conventional indications. A standard protocol followed in emergency CTEA patients included carotid Doppler ultrasonography, computed cerebral tomography (CT), four‐vessel cerebral arteriography, and intravenous heparin. Exclusions from emergency CTEA included coma or cerebral CT scan evidence for either hemorrhagic or ischemic infarction with edema. Operative techniques included standard carotid endarterectomy with Dacron patch or direct suture, eversion endarterectomy, or shortening resection. No mortality or central neurologic complications resulted among the 43 emergency CTEA patients, in comparison to no deaths and one temporary hemiparesis (0.4% central neurologic morbidity) in the 237 elective CTEA patients. Our results suggest that in the absence of coma or cerebral CT scan evidence for an unstable blood–brain barrier, emergency carotid reconstruction can be performed safely and with excellent outcome notwithstanding the magnitude and severity of the acute preoperative neurologic deficit.