Download PDF
Seminars in Neurosurgery 2002; 13(3): 279-286
DOI: 10.1055/s-2002-39821
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Prevention, Identification, and Management of Perioperative Complications of Carotid Endarterectomy

Shyam Krishnan1 , Rocco A. Armonda2 , James H. Rothstein1
  • 1Department of Vascular Surgery, National Naval Medical Center, Bethesda, Maryland
  • 2Department of Neurosurgery, National Naval Medical Center, Bethesda, Maryland
Further Information

Publication History

Publication Date:
24 June 2003 (online)

    Permissions and Reprints

ABSTRACT

Complications from carotid endarterectomy are rare but potentially devastating. The current indications for the operation require a low operative morbidity and mortality. Potential morbidities from carotid endarterectomy include neurological complications (cranial and peripheral nerve injuries, cerebral hyperperfusion syndrome, stroke) and nonneurological complications (neck hematoma/airway obstruction, hypertension, hypotension, cardiac events). Identification of patients at risk for each of these complications allows for preoperative risk reduction and selectively heightened perioperative monitoring. Knowledge of the relevant anatomy and pathophysiology of these complications leads to implementation of appropriate management strategies to minimize their sequelae.

KEYWORDS

Carotid endarterectomy - complications - stroke

REFERENCES

  • 1 Beard J D, Mountney J, Wilkinson J M. et al . Prevention of postoperative wound haematomas and hyperperfusion following carotid endarterectomy.  Eur J Vasc Endovasc Surg . 2001;  21 490-493
    CrossrefPubMedGoogle Scholar
  • 2 Munro F J, Makin A P, Reid J. Airway problems after carotid endarterectomy.  Br J Anaesth . 1996;  76 156-159
    PubMedGoogle Scholar
  • 3 Wong J H, Findlay J M, Suarez-Almazor M E. Hemodynamic instability after carotid endarterectomy: risk factors and associations with operative complications.  Neurosurgery . 1997;  41 35-43
    CrossrefPubMedGoogle Scholar
  • 4 Eagle K A, Berger P B, Calkins H. et al . ACC/AHA guideline update for perioperative cardiovascular evaluation for noncardiac surgery: executive summary Circulation .  2002;  105 1257-1267
    PubMedGoogle Scholar
  • 5 Weitz H H. Perioperative cardiac complications.  Med Clin North Am . 2001;  85 1151-1169
    CrossrefPubMedGoogle Scholar
  • 6 Sprung J, Abdelmalak B, Gottlieb A. et al . Analysis of risk factors for myocardial infarction and cardiac mortality after major vascular surgery.  Anesthesiology . 2000;  93 129-140
    CrossrefPubMedGoogle Scholar
  • 7 AbuRahma A F, Lim R Y. Management of vagus nerve injury after carotid endarterectomy.  Surgery . 1996;  119 245-247
    PubMedGoogle Scholar
  • 8 Curran A J, Smyth D, Sheehan S J, Joyce W, Bouchier Hayes D, Walsh M A. Recurrent laryngeal nerve dysfunction following carotid endarterectomy.  J R Coll Surg Edinb . 1997;  42 168-170
    PubMedGoogle Scholar
  • 9 Forssell C, Kitzing P, Bergqvist D. Cranial nerve injuries after carotid artery surgery: a prospective study of 663 operations.  Eur J Vasc Endovac Surg . 1995;  10 445-449
    PubMedGoogle Scholar
  • 10 Keunen R, Nijmeijer H W, Tavy D. et al . An observational study of preoperative transcranial Doppler examinations to predict cerebral hyperperfusion following carotid endarterectomies.  Neurol Res . 2001;  23 593-598
    CrossrefPubMedGoogle Scholar
  • 11 Hosoda K, Kawaguchi T, Shibata Y. et al . Cerebral vasoreactivity and internal carotid artery flow help to identify patients at risk for hyperperfusion after carotid endarterectomy.  Stroke . 2001;  32 1567-1573
    CrossrefPubMedGoogle Scholar
  • 12 Riles T S, Imparato A M, Jacobowitz G R. et al . The cause of perioperative stroke after carotid endarterectomy.  J Vasc Surg . 1994;  19 206-216
    CrossrefPubMedGoogle Scholar
  • 13 Radak D, Popovic A D, Radicevic S R, Neskovic A N, Bojic M. Immediate reoperation for perioperative stroke after 2250 carotid endarterectomies: differences between intraoperative and early postoperative stroke.  J Vasc Surg . 1999;  30 245-251
    PubMedGoogle Scholar
  • 14 Findlay J M, Marchak B E. Reoperation for acute hemispheric stroke after carotid endarterectomy: is there any value?.  Neurosurgery . 2002;  50 486-493
    PubMedGoogle Scholar
  • 15 Rockman C B, Jacobowitz G R, Lamparello P J. et al . Immediate reexploration for the perioperative neurologic event after carotid endarterectomy: is it worthwhile?.  J Vasc Surg . 2000;  32 1062-1070
    PubMedGoogle Scholar
  • 16 Westerband A, Mills J L, Berman S S, Hunter G C. The influence of routine completion arteriography on outcome following carotid endarterectomy.  Ann Vasc Surg . 1997;  11 14-19
    CrossrefPubMedGoogle Scholar
  • 17 AbuRahma A F, Robinson P A, Short Y S. Management options for post-carotid endarterectomy stroke.  J Cardiovasc Surg . 1996;  37 331-336
    PubMedGoogle Scholar
  • 18 Anzuini A, Briguori C, Roubin G S. et al . Emergency stenting to treat neurological complications occurring after carotid endarterectomy.  J Am Coll Cardiol . 2001;  37 2074-2079
    CrossrefPubMedGoogle Scholar
  • 19 Perler B A, Murphy K, Sternbach Y, Gailloud P, Shake J G. Immediate postoperative thrombolytic therapy: an aggressive strategy for neurologic salvage when cerebral thromboembolism complicates carotid endarterectomy.  J Vasc Surg . 2000;  31 1033-1037
    PubMedGoogle Scholar
      >