Indications for and perioperative management of emergency carotid endarterectomy—report on six cases

Abstract

Emergency carotid endarterectomy (CEA) can be indicated to restore neurological functions or help prevent further stroke in impending stroke patients. We report on our experience of emergency CEA and perioperative patient management in six patients who underwent emergency CEA. We operated on 32 patients with carotid artery stenosis in the last 4 years, 6 of whom were classified as “emergency” patients. Two patients had a crescendo TIA, two had stroke in evolution, and the remaining two had acute severe stroke. In all cases, CEA was performed within 48 h of the last ischemic attack. Postoperatively two patients, each with crescendo TIA and stroke in evolution, and one acute severe stroke patient made a full recovery. One patient with acute stroke died from hypovolemic shock caused by gastrointestinal bleeding. The final postoperative neurological status, as graded by the modified Rankin scale, was Grade 0, of which we had four patients and Grade 2, which described one of our patients. No patient suffered further stroke after CEA in long-term follow-up. Transient postoperative complications occurred in two patients, and angina pectoris in the other. Emergency CEA is beneficial for patients with Crescendo TIA and stroke in evolution in perioperative and long-term follow-up. Postoperatively, however, blood pressure, coronary artery disease, and hemorrhagic complications such as gastrointestinal bleeding must be carefully managed.