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EARLY CAROTID ENDARTERECTOMY IN SYMPTOMATIC PATIENTS – OUR EXPERIENCE

ANTE IVKOŠIĆ ; Sveti Duh University Hospital, Department of Surgery, Division of Vascular Surgery, Zagreb, Croatia
TOMISLAV TRAJBAR ; Sveti Duh University Hospital, Department of Surgery, Division of Vascular Surgery, Zagreb, Croatia
HRVOJE BUDINČEVIĆ ; Sveti Duh University Hospital, Department of Neurology, Zagreb, Croatia
STANKO ANTOLIĆ ; Sveti Duh University Hospital, Department of Surgery, Division of Vascular Surgery, Zagreb, Croatia
NERMIN LOJO ; Sveti Duh University Hospital, Department of Surgery, Division of Vascular Surgery, Zagreb, Croatia
DAGMAR OBERHOFER ; Sveti Duh University Hospital, Department of Anesthesiology, Zagreb, Croatia

Abstract

Carotid endarterectomy is the gold standard as a therapeutic regimen for patients with high grade symptomatic stenosis of the internal carotid artery (ACI). This study analyzed the effect of early carotid endarterectomy in patients undergoing an operative procedure 2-3 weeks after the development of ischemic neurologic symptoms, considering the frequency and type of complications in the postoperative period. Patients included in this study were those with significant symptomatic ACI stenosis (70%-99%), which caused ischemic stroke or transient ischemic attacks (TIA). Patients with ischemic stroke were operated within twenty days of the initial neurologic event, whilst in those with symptoms of TIA, surgery was performed immediately after diagnostic work-up. In all cases, carotid endarterectomy was performed under general anesthesia with the use of protective intraluminal shunt. In the vast majority of cases, tucking or Kunlin’s sutures of the distal intima were applied. All procedures were performed between January 2008 and October 2012, and the total number of patients was 69. All patients underwent the same follow up program. Follow up carotid ultrasound was performed routinely on postoperative day 7 and at 1, 3, 6 and 12 months. In this study, 27 (39%) patients suffered minor ipsilateral stroke and 42 (61%) patients had TIA symptoms with verified significant ACI stenosis. Postoperative complications were observed in four (5.26%) patients. Two (2.63%) patients developed ischemic stroke after the procedure and two (2.63%) patients developed ACI restenosis in the late postoperative period and were treated by endovascular stenting. In conclusion, we found that early carotid endarterectomy was of greater benefit than delayed endarterectomy, which is in keeping with the published studies. The leading observation was that in selected patients, early carotid end-
arterectomy was not associated with a higher risk of postoperative complications in comparison with delayed endarterectomy and could be performed safely.

Keywords

early carotid endarterectomy; ischemic stroke

Hrčak ID:

136989

URI

https://hrcak.srce.hr/136989

Publication date:

27.3.2015.

Article data in other languages: croatian

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