Advertisement

Carotid Endarterectomy

  • Sachinder Singh Hans
Chapter

Abstract

Extracranial carotid artery stenosis is accountable for 10–20% of all ischemic strokes. Carotid endarterectomy (CEA) prevents major stroke in patients presenting with focal TIAs (transient ischemic attacks) and minor stroke. Carotid endarterectomy can be performed under cervical block anesthesia (awake patient) or under general anesthesia. Most patients can undergo CEA safely without the use of indwelling shunt. In awake patients undergoing CEA under cervical block anesthesia, the need for indwelling shunt is approximately 10% and under GA with EEG monitoring is 12–18%. Post carotid endarterectomy stroke occurs in 2–5% of patients undergoing CEA and is most often the result of plaque embolization. Post CEA site thrombosis and intracerebral hemorrhage following CEA are other causes of postoperative stroke. Perioperative myocardial infarction, cranial nerve palsy, and hematoma in the neck are other complications of CEA.

Keywords

Carotid endarterectomy Transient ischemic attack Stroke Indwelling shunt Stump pressure Post carotid endarterectomy stroke Hematoma neck Cranial nerve palsy 

References

  1. 1.
    Barnett HJM, Taylor DW, Eliasziw M, et al. Benefits of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med. 1998;339:1415–25.CrossRefGoogle Scholar
  2. 2.
    Rothwell PM, Eliasziw M, Gutnikov SA, Warlow CP, Barnett HJM. Endarterectomy for symptomatic carotid stenosis in related to clinical subgroup and timing of surgery. Lancet. 2004;363:915–24.CrossRefGoogle Scholar
  3. 3.
    Rothwell PM, GIles MF, Flossmann E, Lorelock CE, Redgrave JN, Warlon CP, et al. A simple curve (ABCD) to identify individuals at high early risk of stroke after transient ischemic attack. Lancet. 2005;336:29–36.CrossRefGoogle Scholar
  4. 4.
    Johnston SC, Sidney S. Validation of a 4-point predication rule to stratify short term stroke risk after TIA. Stroke. 2005;36:430.CrossRefGoogle Scholar
  5. 5.
    Eliasziw M, Kennedy J, Hill MD, Buchan AM, Barnett HJM. Early risk of stroke after a transient ischemic attack in patients with internal carotid disease. CMAJ. 2004;170(7):1105–9.CrossRefGoogle Scholar
  6. 6.
    Hill MD, Gladstone DJ. Patients with transient ischemic attack or minor stroke should be admitted to the hospital. Stroke. 2006;37:1137–8.CrossRefGoogle Scholar
  7. 7.
    Caplan LR. Curr Atheroscler Rep. 2006;8:276–80.CrossRefGoogle Scholar
  8. 8.
    Sheikh K, Bullock C. Variation and changes in state-specific carotid endarterectomy and 30-day mortality rates, Unitsed States, 1991-2000. J Vasc Surg. 2003;38(4):779–84.CrossRefGoogle Scholar
  9. 9.
    Yadev JS, Wholey MH, Kuntz RE, Foyad P, et al. Protected carotid artery stenting versus endarterectomy in high risk patients. N Engl J Med. 2004;351:1493–501.CrossRefGoogle Scholar
  10. 10.
    Silver FL, Mackey A, Clark WM, Brooks W, et al. Safety of stenting and endarterectomy by symptomatic status in the Carotid Revascularization Endarterectomy Versus Stenting Trial (CREST). Stroke. 2011;42:675–80.CrossRefGoogle Scholar
  11. 11.
    Brott TG, Hobson RW, Howard G, Roubin GS, The Crest Investigators, et al. Stenting versus endarterectomy for treatment of carotid artery stenosis. N Engl J Med. 2006;355:1600–11.Google Scholar
  12. 12.
    General anesthesia versus local anesthesia for carotid surgery (GALA): a multicentre, randomized controlled trial. Lancet. 2008;372:2132–42.Google Scholar
  13. 13.
    Schneider JD, Droste JS, Schindler N, Golan JP, Bernstein LP, Rosenberg RS. Carotid endarterectomy with routine electroencephalography and selective shunting. J Vasc Surg. 2002;35:1114–22.CrossRefGoogle Scholar
  14. 14.
    Calligaro KD, Dougherty MJ. Correlation of carotid artery stump pressure and neurological changes during 474 carotid endarterectomies performed in awake patients. J Vasc Surg. 2005;42:684–9.CrossRefGoogle Scholar
  15. 15.
    Hans SS, Jareunpoon O. Prospective evaluation of electroencephalography, carotid artery stump pressure and neurological changes during 314 consecutive carotid endarterectomies performed in awake patients. J Vasc Surg. 2007;45:511–5.CrossRefGoogle Scholar
  16. 16.
    Berguer R. Operations on internal carotid artery. In:Function and surgery of carotid and vertebral arteries. Philadelphia: Wolters Kluwer; 2014.Google Scholar
  17. 17.
    Baker WH, Littooy FN, Hayes AC, Dorner DB, Stubbs D. Carotid endarterectomy without a shunt: the control series. J Vasc Surg. 1984;1(1):50–6.CrossRefGoogle Scholar
  18. 18.
    Goodney PP, Likosky DS, Cronenwett JL. Factors associated with stroke or death after carotid endarterectomy in Northern New England. J Vasc Surg. 2008;48:1139–45.CrossRefGoogle Scholar
  19. 19.
    Norris JW, Zhu CZ, Bornstein NM, Chamber BR. Vascular risks of asymptomatic carotid stenosis. Stroke. 1991;22:1485–90.CrossRefGoogle Scholar

Copyright information

© The Author(s) 2018

Authors and Affiliations

  • Sachinder Singh Hans
    • 1
    • 2
    • 3
  1. 1.Medical Director of Vascular and Endovascular ServicesHenry Ford Macomb HospitalClinton TownshipUSA
  2. 2.Chief of Vascular SurgerySt. John Macomb HospitalWarrenUSA
  3. 3.Department of SurgeryWayne State University School of MedicineDetroitUSA

Personalised recommendations