Surgical Treatment for Carotid Artery Stenosis

Kim, Dae Hyun; Yi, In Ho; Youn, Hyo Chul; Kim, Bum Shik; Cho, Kyu Seok; Kim, Soo Cheol; Park, Joo Chul; Hwang, Eun Gu

Abstract

BACKGROUND: Carotid endarterectomy is an effective treatment modality in patients with severe carotid artery stenosis, but it may result in serious postoperative complications. We analyzed the results of the carotid endarterectomy performed in our institution to reduce the complications related to the carotid endarterectomy. MATERIAL AND METHOD: We analyzed retrospectively the medical records of 74 patients (76 cases) who underwent carotid endarterectomy for carotid artery stenosis by a single surgeon from February 1996 to July 2004. RESULT: There were 64 men and 10 women. The mean age of the patients was 63.6 years old. Carotid endarterectomy only was performed in 63 cases, carotid endarterectomy with patch angioplasty in 8 cases, and carotid endarterectomy with segmental resection of internal carotid artery and end to end anastomosis in 5 cases. Intra-arterial shunt was used in 29 cases. The mean back pressures of internal carotid arteries checked after clamping common carotid arteries and external carotid arteries were 23.48+/-10.04 mmHg in 25 cases with changes in electroencephalography (group A) and 47.16+/-16.04 mmHg in 51 cases without changes in electroencephalography (group B). There was no statistical difference in the mean back pressure of internal carotid arteries between two groups (p=0.095), but the back pressures of internal carotid arteries of all patients with changes in electroencephalography were under 40 mmHg. When there was no ischemic change of electroencephalography after clamping common carotid artery and external carotid artery, we did not make use of intra-arterial shunt regardless of the back pressure of internal carotid artery. Operative complications were transient hypoglossal nerve palsy in four cases, cerebral hemorrhage occurred at previous cerebral infarction site in two cases, mild cerebral infarction in one case, hematoma due to anastomosis site bleeding in one case, and upper airway obstruction due to laryngeal edema probably caused by excessive retraction during operation in two cases. One patient expired due to cerebral hemorrhage occurring at previous cerebral infarction site.
CONCLUSION
Carotid endarterectomy is a safe operative procedure showing low operative mortality. We suggest that intra-arterial shunt usage should be decided according to the ischemic change of electroencephalography regardless of the back pressure of internal carotid artery. Excessive retraction during operation should be avoided to prevent upper airway obstruction due to laryngeal edema and if upper airway obstruction is suspected, prompt management is essential.