title: Reducing the risk of intraoperative neurological complications during carotid endarterectomy with early distal control of the internal carotid artery.
abstract: OBJECTIVE
  To assess the feasibility and effectiveness of a modified surgical technique with early clamping of the distal internal carotid artery (ICA) during carotid endarterectomy in a single centre experience.
  
  
  METHODS
  Retrospective study, teaching hospital.
  
  
  METHODS
  Between 1996 and 2002, 2235 CEAs were performed. Until April 1999, the intra-operative strategy consisted of standard isolation and dissection of the carotid bifurcation preliminary to ICA clamping (group 1; 1090 interventions). Starting from May 1999, we performed early isolation and clamping of the distal ICA, followed by dissection of the carotid bifurcation and clamping of the external and common carotid artery (group 2; 1145 interventions).
  
  
  RESULTS
  The modified technique was feasible in all the patients of group 2. In group 2 there was a significantly lower incidence of neurological deficit on waking than in group 1 (0.4% and 1.8%, respectively; p=0.02).
  
  
  CONCLUSIONS
  Early distal control of the internal carotid artery during CEA is feasible and could contribute to reducing intra-operative neurological events.
authors.affiliation: Department of Vascular Surgery, University of Florence, Viale Morgagni 85, 50134 Firenze, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Pratesi
authors.forename: W
authors.initials: W
authors.lastname: Dorigo
authors.forename: A Alessi
authors.initials: AA
authors.lastname: Innocenti
authors.forename: L
authors.initials: L
authors.lastname: Azas
authors.forename: E
authors.initials: E
authors.lastname: Barbanti
authors.forename: R
authors.initials: R
authors.lastname: Lombardi
authors.forename: G
authors.initials: G
authors.lastname: Pratesi
authors.forename: R
authors.initials: R
authors.lastname: Pulli
mesh_terms: D002343:Carotid Artery, Internal / Q000601:surgery*; D003250:Constriction; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D020766:Intracranial Embolism / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000517:prevention & control*