title: Risk factors for stroke during surgery for carotid body tumors.
abstract: BACKGROUND
  Removing carotid body tumors (CBTs) carry the risk of operative morbidity including stroke. We evaluated the risk factors for stroke related to resection of CBTs.
  
  
  METHODS
  We retrospectively reviewed the records of 17 procedures performed on 16 patients with CBT between March 1998 and September 2008.
  
  
  RESULTS
  The study population consisted of 5 men and 11 women, of mean age 41.7 years (range: 23-62 years). At surgery, 8 cases (47%) were localized and classified as Shamblin class I, 4 cases (23.5%) as class II, and 5 cases (29.4%) as class III. Four patients had postoperative stroke (23.5%), with Shamblin classification related to the incidence of stroke (P = 0.041). In contrast, neither tumor size (P = 0.412) nor heparin injection before internal carotid artery (ICA) manipulation (P = 0.538) was associated with stroke. Although preoperative embolization of the tumor feeder did not significantly reduce the stroke rate (P = 0.579), early external carotid artery (ECA) division in patients with class II and III tumors was effective (P = 0.008). Internal carotid artery (ICA) manipulation, including reconstruction, ligation, and repair of injury, significantly increased the incidence of stroke (P = 0.029), as did ICA ligation without reconstruction (P = 0.044).
  
  
  CONCLUSIONS
  Internal carotid artery manipulation, including reconstruction, ligation, and repair of injury, significantly increased the incidence of stroke. For uncomplicated CBT resection, careful preoperative planning, especially for patients with class II and III tumors, is mandatory to avoid inadvertent ICA manipulation necessitated by bleeding. Early ECA division during the operation rather than preoperative percutaneous embolization in patients with class II and III tumors was significantly effective in reducing the stroke rate.
authors: Division of Vascular Surgery, Department of Surgery, University of Ulsan Medical College and Asan Medical Center, 388-1 Pungnap2-dong, Songpa-gu, Seoul, 138-736, South Korea.
authors: Jun Gyo
authors: JG
authors: Gwon
authors: Tae-Won
authors: TW
authors: Kwon
authors: Hyangkyoung
authors: H
authors: Kim
authors: Yong-Pil
authors: YP
authors: Cho
mesh_terms: D000328:Adult; D017677:Age Distribution; D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery*; D002345:Carotid Body Tumor / Q000175:diagnosis / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods; D014057:Tomography, X-Ray Computed / Q000379:methods; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D055815:Young Adult