Early stroke after carotid endarterectomy: A case series during a 5-year period

Abstract

Introduction. Carotid endarterectomy is an efficient surgical procedure of primary and secondary prevention of ischemic stroke in asymptomatic and symptomatic patients with extracranial carotid artery disease. Material and Methods. In this paper we analyzed incidence, risk factors, potential causes and preventive measures for early stroke after carotid endarterectomy in patients (809) who underwent surgery for carotid artery stenosis at the Clinic of Vascular and Endovascular Surgery of the Clinical Center of Vojvodina in Novi Sad during a five year period (April 2013 - March 2018). Results and Discussion. Early operative stroke was registered in 12 patients with no significant difference between symptomatic (2.8%) and asymptomatic (1.1%) patients (odds ratio - 2,56, 95% confidence interval - 0.8063 to 8.1770 standard deviation 1,596; p = 0,11). Contralateral carotid occlusion (odds ratio - 3.1154, 95% confidence interval - 1.1620 to 8.3522, p = 0.0239) and no dual antiplatelet therapy (odds ratio - 3.1154, 95% confidence interval - 1.8537 to 526.4871; p = 0.0169) were pointed out as risk factors for operative stroke. Most of the perioperative and early postoperative strokes after carotid endarterectomy were due to arterial-arterial thromboembolism, intracerebral hemorrhage and acute carotid occlusion that developed rarely and were associated with severe neurological deficit. Conclusion. Even though our results are in agreement with the literature data, additional measures for surgical quality control would further decrease the incidence of operative stroke.