Preoperative Evaluation and Carotid Endarterectomy for Severe Carotid Stenosis

We performed carotid endarterectomy (CEA) for 24 patients with severe carotid stenosis (greater than 90%) from 2003 to 2007. There were 21 males and 3 females with a mean age of 69 (58-89 years old). Seven were asymptomatic and 17 symptomatic. Carotid angiograms indicated our patients fell into 3 groups: simple stenosis in 12, pseudo-occlusion in 7, and pseudo-occlusion-like in 5. We retrospectively examined clinical features and operative findings and in this article discuss perioperative management for CEA. Although there was no perioperative morbidity or mortality, thrombotic carotid occlusion was recognized in 2 patients after arteriotomy (CEA was successfully performed in 1; another was ligated at the origin of internal carotid artery). CEA is a useful measure for patients with severe carotid stenosis under our perioperative management protocol. To minimize perioperative complications, preoperative examination of coronary artery disease and evaluation for the distal end of atheromatous plaque, meticulous operative and anti-ischemic procedure, and postoperative risk management for CEA are important.