title: Perioperative ischemic complications of the brain after carotid endarterectomy.
abstract: BACKGROUND
  The potential morbidity of cerebral ischemia after carotid endarterectomy (CEA) has been recognized, but its reported incidence varies widely.
  
  
  OBJECTIVE
  To prospectively evaluate the development of cerebral ischemic complications in patients treated by CEA at a high-volume cerebrovascular center.
  
  
  METHODS
  Fifty patients with moderate or severe carotid stenosis awaiting CEA were studied with perioperative diffusion-weighted imaging of the brain and standardized neurological evaluations. Microsurgical CEA was performed by 1 of 2 vascular neurosurgeons. Radiological studies were evaluated by faculty neuroradiologists who were blinded to the details of the clinical situation.
  
  
  RESULTS
  Preoperative diffusion-weighted imaging studies were performed within 24 hours of surgery. A second study was obtained within 24 (92% of patients), 48 (4% of patients), or 72 (4% of patients) hours after surgery. Intraluminal shunting was used in 1 patient (2%), and patch angioplasty was used in 2 patients (4%). No patient had diffusion-weighted imaging evidence of procedure-related cerebral ischemia. Nonischemic complications consisted of postoperative confusion in an 87-year-old man with a urinary tract infection and a marginal mandibular nerve paresis in another patient. Radiological studies were normal in both patients.
  
  
  CONCLUSIONS
  CEA is a relatively safe procedure that may be performed with an acceptable risk of cerebral ischemia in select patients. The low rate of ischemic complications associated with CEA sets a standard to which other carotid revascularization techniques should be held. The current results are presented with a discussion of the senior author's preferred surgical technique and a brief review of the literature.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St Joseph's Hospital and Medical Center, Phoenix, Arizona 85013, USA.
authors.forename: Matthew O
authors.initials: MO
authors.lastname: Hebb
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Heiserman
authors.forename: Kirsten P N
authors.initials: KP
authors.lastname: Forbes
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Zabramski
authors.forename: Robert F
authors.initials: RF
authors.lastname: Spetzler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000150:complications / Q000473:pathology; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology*; D016893:Carotid Stenosis / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography; D038524:Diffusion Magnetic Resonance Imaging; D016894:Endarterectomy, Carotid / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000473:pathology*; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome