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DOI: 10.1055/s-2007-967673
Significance of contralateral occlusion of the internal carotid artery with regard to neurological complication rates following carotid thrombendarterectomy
Objective: The effect of contralateral occlusion of the internal carotid artery (CA) on perioperative neurological complications following surgical desobliteration (CEA) of the carotid artery is discussed controversially (no effect versus increase of complication rate). The number of neurological complications within 30 days following CEA was investigated in patients with or without CA.
Methods: 335 consecutive patients undergoing CEA were enrolled from 1991 to 2005, 173 underwent concomitant cardiac surgery with cardiopulmonary bypass. Group A consisted of 260 patients without CA and group B of 75 patients with CA. The rate of neurological complications (peripheral nerve damage, TIA/PRIND, and stroke) and the Rankin index difference within 24h and 30d postoperatively was compared (Chi square test).
Results: The occurrence of strokes within 24h was increased significantly (p=0.006) in group B (8 patients, 11%) compared to A (8 patients, 3.1%). Percentages of TIA and PRIND did not differ between groups (group A 2.3% versus group B 1.3%, p=0.33). The rate of neurological complications in all and in particular for peripheral neurological damage, TIA/PRIND, and stroke did not differ within the overall 30-day-period post surgery. The overall high number of complications can be explained with the high percentage of concomitant cardiac procedures.
Conclusion: Contralateral carotid occlusion did not affect the frequency of peripheral nerve damage and TIA/PRIND following CEA. However, a significant difference with regard to the stroke rate within 24h post surgery was found in this study.