title: Carotid endarterectomy. The unreliability of intraoperative monitoring in patients having had stroke or reversible ischemic neurologic deficit.
abstract: We reviewed 125 patients who had had stroke or reversible ischemic neurologic deficits (RIND) and who underwent carotid endarterectomy, with follow-up extending to six years. Phase I patients (n = 36) had endarterectomy and shunt placement at operation by surgeons' preference. The rate of postoperative neurologic deficit was 8%. Phase II patients (n = 36) had endarterectomy monitored by EEG and stump pressures. Postoperative deficits occurred in 9%. The EEGs and stump pressures in these patients were "normal"; therefore, no shunt was used. Phase III patients (n = 41) had endarterectomy again monitored by EEG and stump pressure. Despite normal EEGs or stump by EEG and stump pressure. Despite normal EEGs or stump pressure, all patients underwent endarterectomy with a temporary indwelling shunt. No complications occurred. In 368 patients operated on for transient ischemic attacks alone, the operative stroke rate was 1.6%. Stump pressure and EEG are unreliable indicators of cerebral perfusion during carotid endarterectomy in patients who have suffered stroke or RIND. Use of a temporary shunt is indicated in all of these patients.
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002340:Carotid Artery Diseases / Q000601:surgery*; D002343:Carotid Artery, Internal / Q000601:surgery; D002533:Cerebral Angiography; D002561:Cerebrovascular Disorders / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control / Q000628:therapy*; D004569:Electroencephalography; D004691:Endarterectomy / Q000379:methods*; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications