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Titolo:
Immediate reexploration for the perioperative neurologic event after carotid endarterectomy: Is it worthwhile?
Autore:
Rockman, CB; Jacobowitz, GR; Lamparello, PJ; Adelman, MA; Woo, D; Schanzer, A; Gagne, PJ; Landis, R; Riles, TS;
Indirizzi:
NYU, Med Ctr, Div Vasc Surg, New York, NY 10016 USA NYU New York NY USA 10016 Med Ctr, Div Vasc Surg, New York, NY 10016 USA
Titolo Testata:
JOURNAL OF VASCULAR SURGERY
fascicolo: 6, volume: 32, anno: 2000,
pagine: 1062 - 1068
SICI:
0741-5214(200012)32:6<1062:IRFTPN>2.0.ZU;2-X
Fonte:
ISI
Lingua:
ENG
Soggetto:
MANAGEMENT; STROKE; THROMBOSIS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
15
Recensione:
Indirizzi per estratti:
Indirizzo: Rockman, CB NYU, Med Ctr, Div Vasc Surg, 530 1st Ave,Suite 6F, New York, NY 10016 USA NYU 530 1st Ave,Suite 6F New York NY USA 10016 k, NY 10016 USA
Citazione:
C.B. Rockman et al., "Immediate reexploration for the perioperative neurologic event after carotid endarterectomy: Is it worthwhile?", J VASC SURG, 32(6), 2000, pp. 1062-1068

Abstract

Purpose: When managing a new neurologic deficit after carotid endarterectomy (CEA), the surgeon is often preoccupied with determining the cause of the problem, requesting diagnostics tests, and deciding whether the patient should be surgically reexplored. The goal of this study was to analyze a series of perioperative neurologic events and to determine if careful analysisof their timing and mechanisms can predict which cases are likely to improve with reoperation. Methods: A review of 2024 CEAs performed from 1985 to 1997 revealed 38 patients who manifested a neurologic deficit in the perioperative period (1.9%). These cases form the focus of this analysis. Results: The causes of the events included intraoperative clamping ischemia in 5 patients (13.2%); thromboembolic events in 24 (63.2%); intracerebralhemorrhage in 5 (13.2%); and deficits unrelated to the operated artery in 4 (10.5%). Neurologic events manifesting in the first 24 hours after surgery were significantly more Likely to be caused by thromboembolic events thanby other causes of stroke (88.0% vs 12.0%, P < .002); deficits manifestingafter the first 24 hours were significantly more likely to be related to other causes. Of 25 deficits manifesting in the first 24 hours after surgery, 18 underwent immediate surgical reexploration. Intraluminal thrombus was noted in 15 of the 18 reexplorations (83.3%); any technical defects were corrected. After the 18 reexplorations, in 12 cases there was either completeresolution of or significant improvement in the neurologic deficit that had been present (66.7%). Conclusions: Careful analysis of the timing and presentation of perioperative neurologic events after CEA can predict which cases are likely to improve with reoperation. Neurologic deficits that present during the first 24 hours after CEA are likely to be related to intraluminal thrombus formation and embolization. Unless another etiology for stroke has clearly been established, we think immediate reexploration of the artery without other confirmatory tests is mandatory to remove the embolic source and correct any technical problems. This will Likely improve the neurologic outcome in these patients, because an uncorrected situation would lead to continued embolization and compromise.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 22/10/20 alle ore 12:43:27