Clinical experiences of 400 cases of carotid endarterectomy

Abstract

Objective Perioperative treatment strategies and clinical efficacy were discussed in this presentation when carotid endarterectomy (CEA) was performed for severe carotid artery stenosis patients.  Methods CEA was underwent for 356 patients with severe carotid atherosclerotic stenosis in Department of Neurosurgery of Dalian Municipal Central Hospital from March 2009 to August 2013. Severe carotid artery stenosis (70%-99%) were diagnosed according to clinical manifestations and multiple tests, which included neck vascular Doppler ultrasound, transcranial Doppler ultrasonography (TCD), head and neck CTA or MRA, and so on. Forty-four of 356 patients suffered severe bilateral stenosis. Thus a total of 400 CEA was performed in 356 patients in this discussion. General anesthesia was applied. Among all of the CEA, 120 was operated in the standard approach; eversion carotid endarterectomy was underwent in 255 cases; membrane patch was used in 25 cases. Only 32 cases of 400 were adapted transit shunt.  Results All of the operations were successful. Most of patients had significant improvements in clinical presentation. Imaging studies also revealed better cerebral blood flow or perfusion. Head lightness or dizziness were disappeared. Motor/sensory function and memory were improved in most cases. Postoperative complications were found in a total of 12 cases, including a few days of hoarseness in one case; small contralateral cerebral hemorrhage in one case; restenosis in one case; wound hematoma in one case; partial seizures in 2 cases; middle cerebral artery occlusion in 2 cases; contralateral cerebral infarction in 4 cases. The follow-up (1-36 months) showed most of complications were resolved. Conclusions A skillful, standard and experienced surgical team is important and essential for CEA. It is necessary to assess, monitor and treat perioperative patients closely, which may reduce surgical mortality, effectively prevent from occurrence of postoperative complications, and improve patients' quality of life after surgery.

doi：10.3969/j.issn.1672-6731.2014.01.008

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