Reoperation for neurological complications following carotid endarterectomy.
BACKGROUND
There remains a dilemma whether or not to re-explore the carotid artery when a neurological complication occurs after carotid endarterectomy. This study reviewed the indications for, findings and clinical outcomes following re-exploration.


METHODS
Patients who experienced transient or permanent neurological events following carotid endarterectomy were identified from a prospectively compiled computerized database. Case notes were retrieved to determine time to onset of symptoms, use of carotid artery imaging and details about patients who had surgical re-exploration, and outcomes.


RESULTS
Some 780 consecutive carotid endarterectomies were performed over 16 years, with an incidence of major stroke or death of 2.3 per cent (18 patients). Fifty-one patients experienced transient or permanent neurological events following surgery, 25 of whom underwent re-exploration. The findings included carotid thrombosis (ten patients), flap or other technical cause (three), haematoma (two) and no abnormality (ten). The neurological outcome after 30 days was similar, whether or not the carotid artery was re-explored.


CONCLUSIONS
Carotid artery re-exploration was undertaken in approximately half of the patients who developed neurological complications following carotid endarterectomy. Although the cause was identified and a secondary procedure was undertaken in 14 of 25 patients, there was no improvement in clinical outcome at 30 days compared with that of patients managed non-operatively.
Stewart
A H R
AH
Department of Vascular Surgery, Bristol Royal Infirmary, Bristol, UK. astewart@doctors.org.uk
McGrath
C M
CM
Cole
S E A
SE
Smith
F C T
FC
Baird
R N
RN
Lamont
P M
PM
D000368:Aged; D000704:Analysis of Variance; D002340:Carotid Artery Diseases / Q000601:surgery*; D004630:Emergencies; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology* / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation / Q000706:statistics & numerical data; D016896:Treatment Outcome