title: Pitfalls during carotid endarterectomy.
abstract: It is estimated that between 1971 and 1987 the number of carotid endarterectomies has increased from 15,000 to over 85,000 per year. Unless the procedure can be performed safely with a combined morbidity and mortality which is below the yearly risk of stroke (5%) for patients with symptomatic carotid artery disease, one should reconsider this operation as a therapeutic option. We review our experience with 891 carotid endarterectomies performed between January 1979 and June 1987. There were 579 (65%) men and 312 (35%) women of ages from 34 to 82 (median 65); risk factors included diabetes mellitus 213 (14%), hypertension 603 (68%), and smoking 630 (70%). Clinical presentation consisted of transient ischemic attacks 506 (57%), cerebral infarction with minimal neurological residual 252 (28%), stroke in evolution 3 (0.3%) and, asymptomatic stenosis 130 (15%). All patients were operated on under endotracheal anesthesia with transoperative monitoring of intra-arterial pressure, central venous pressure and arterial blood gases. Thiopental (3-5 mg/kg) and lidocaine (1 mg/kg) were given for induction and at 15 minute intervals during carotid cross-clamping. Intraluminal shunts were used in 13 (2%). A conventional (open) endarterectomy was performed in 561 (63%) and a limited endarterectomy (closed) in 330 (37%). Complications included 11 (1%) deaths, 26 (3%) developed a major neurological deficit that persisted, 30 (3%) had perioperative TIA's which resolved completely. Of the patients with preoperative neurological deficits, 33 (4%) recovered. Therefore, at one month after surgery, 854 (96%) were either as well or better than preoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Neurosurgery, Henry Ford Hospital, Detroit, Michigan.
authors.forename: F G
authors.initials: FG
authors.lastname: Diaz
authors.forename: J I
authors.initials: JI
authors.lastname: Ausman
authors.forename: G M
authors.initials: GM
authors.lastname: Malik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002339:Carotid Arteries / Q000601:surgery*; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000209:etiology; D002544:Cerebral Infarction / Q000209:etiology / Q000401:mortality; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000601:surgery; D004691:Endarterectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D005260:Female; D006406:Hematoma / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010523:Peripheral Nervous System Diseases / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology