gms | German Medical Science

Introduction: The main complications associated with carotid artery surgery for stenosis are stroke or paresis of the hypoglossal or facial nerve. Also, silent embolic cerebral lesions might occur during or after carotid surgery, which can be detected in diffusion-weighted MRI. The objective of the study was to detect risk factors for perioperative silent embolisms and other perioperative complications.

Material and methods: We herein present a prospective study with 97 patients undergoing carotid endarterectomy in general anaesthesia. After surgery neurological examination and diffusion-weighted MRI was carried out in all patients. Additionally, duplex colour ultrasound was performed to quantify the rate of re-stenosis. Moreover, we analyzed the correlation between medical treatment, surgical technique or co-morbidities and the rate of restenosis.

Results: New ischemic changes were detected in 20% of patients after surgery. While a significant correlation between new ischemic changes and the perioperative use of shunts (p=0.016) was found, there was no correlation between several surgical techniques, co-morbidities, age or gender of patients and the occurrence of new ischemic events. After 3, 6 and 12 months a duplex colour ultrasound was performed to evaluate the long-term results of the carotid surgery. A significant correlation between the use of statins and the rate of restenosis (p=0.01) was found.

Conclusion: Overall, the rate of ischemic changes detected is still low. Most of the detected changes were not clinically apparent. Thus in our opinion a routine MRI-scanning postoperatively is not recommendable. According to our data the intraoperative use of shunts should be avoided to prevent perioperative ischemic events. Also, the application of statins seems favourable to further lower the rate of re-stenosis.