During 1982 to 1993, 263 patients were operated upon with 317 procedures of cervical carotid endarterectomy. 170 patients were submitted only to carotid endarterectomy and 93 to combined carotid revascularization and cardiac procedure (93% aorto-coronary by-pass graft). So the selection of patients was: reversible ischemia 44%, stroke 18,2%, asymptomatic patients 37%. In the stroke group, no patient was operated on an emergency. In the asymptomatic subgroup (99 patients) casual discovery was in 48 patients (48,4%). All but 5 patients with unstable angina operated upon only echotomography, were submitted to surgery after angiographic exploration. General anesthesia was utilized for 202 patients, and local for 61 patients. As monitoring for cerebral protection we employed stump pressure in the general anesthesia group; in the last 50 cases of the group submitted to combined carotid and cardiac surgery we utilized the hypothermic extracorporeal circulation at 25°C. External temporary shunt was adopted only in 28 patients and pharmacological hypertension in 14. The bilateral carotid stenosis subgroup included 49 patients and 32 (65,3%) were submitted to simultaneous bilateral carotid endarterectomy. The longitudinal arteriotomy was always utilized and only in 11 patients was sutured with patch. In 15 patients the endarterectomy was associated with internal carotid artery shortening for kinking, coiling or aneurysm. The surgical results were studied in terms of uneventful postoperative course (88,3%), reversible complications (4,1%) and in terms of surgical mortality (0,6%) in the subgroup submitted only to carotid endarterectomy and (12,9%) for the combined subgroup. Overall operative outcome at 10 years was: unrelated death (11,6%), global actuarial survival was 65,1% (CL 70%=52,8%-72,4%), for only endarterectomy subgroup was 73,8% (CL70%=66.4-81.2) and for combined carotid and cardiac surgery patients 46.3% (CL70%=21.4-71.2)
Carotid endarterectomy, eleven years' experience
BEGHI, CESARE;
1995-01-01
Abstract
During 1982 to 1993, 263 patients were operated upon with 317 procedures of cervical carotid endarterectomy. 170 patients were submitted only to carotid endarterectomy and 93 to combined carotid revascularization and cardiac procedure (93% aorto-coronary by-pass graft). So the selection of patients was: reversible ischemia 44%, stroke 18,2%, asymptomatic patients 37%. In the stroke group, no patient was operated on an emergency. In the asymptomatic subgroup (99 patients) casual discovery was in 48 patients (48,4%). All but 5 patients with unstable angina operated upon only echotomography, were submitted to surgery after angiographic exploration. General anesthesia was utilized for 202 patients, and local for 61 patients. As monitoring for cerebral protection we employed stump pressure in the general anesthesia group; in the last 50 cases of the group submitted to combined carotid and cardiac surgery we utilized the hypothermic extracorporeal circulation at 25°C. External temporary shunt was adopted only in 28 patients and pharmacological hypertension in 14. The bilateral carotid stenosis subgroup included 49 patients and 32 (65,3%) were submitted to simultaneous bilateral carotid endarterectomy. The longitudinal arteriotomy was always utilized and only in 11 patients was sutured with patch. In 15 patients the endarterectomy was associated with internal carotid artery shortening for kinking, coiling or aneurysm. The surgical results were studied in terms of uneventful postoperative course (88,3%), reversible complications (4,1%) and in terms of surgical mortality (0,6%) in the subgroup submitted only to carotid endarterectomy and (12,9%) for the combined subgroup. Overall operative outcome at 10 years was: unrelated death (11,6%), global actuarial survival was 65,1% (CL 70%=52,8%-72,4%), for only endarterectomy subgroup was 73,8% (CL70%=66.4-81.2) and for combined carotid and cardiac surgery patients 46.3% (CL70%=21.4-71.2)
I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
