Journal
EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
Volume 46, Issue 2, Pages 161-170Publisher
W B SAUNDERS CO LTD
DOI: 10.1016/j.ejvs.2013.05.005
Keywords
Carotid endarterectomy; Pen-operative stroke; Monitoring; Quality control
Categories
Funding
- UK Stroke Association
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The objective of this review was to identify causes of stroke/death after carotid endarterectomy (CEA) and to develop transferable strategies for preventing stroke/death after CEA, via an overview of a 21-year series of themed research and audit projects. Three preventive strategies were identified: (i) intra-operative transcranial Doppler (TCD) ultrasound and completion angioscopy which virtually abolished intra-operative stroke, primarily through the removal of residual luminal thrombus prior to restoration of flow; (ii) dual antiplatelet therapy with a single 75-mg dose of clopidogrel the night before surgery in addition to regular 75 mg aspirin which virtually abolished post-operative thromboembolic stroke and may also have contributed towards a decline in stroke/death following major cardiac events; and (iii) the provision of written guidance for managing post-CEA hypertension which was associated with virtual abolition of intracranial haemorrhage and stroke as a result of hyperperfusion syndrome. The pathophysiology of pen-operative stroke is multifactorial and no single monitoring or therapeutic strategy will reduce its prevalence. Two of the preventive strategies developed during this 21-year project (pen-operative dual antiplatelet therapy, published guidance for managing post-CEA hypertension) are easily transferable to practices elsewhere. (C) 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.
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