Factors Deciding Outcome of the Patient after Carotid Endarterectomy

From the standpoint of a long-term follow-up study and our method of carotidendarterectomy (CEA), we studied factors for determinating prognoses of the patients who underwent CEA in our institute. Fifty-one patients (46 males and 5 females) underwent CEA during the past 11 years. The mean age was 64.5 and the mean follow-up period was 57.2 months. Indications for CEA were TIA, RIND, and minor stroke with carotid stenosis of over 50% and/or ulcer formation. When carotid angiogram showed stenosis of over 75%, the lesion was operated on, even if the patient did not have clinical symptoms. As intraoperative monitorings, carotid stump pressure, SEP, EEG, and carotid blood flow measurement were performed. During the operation, blood pressure was raised when it was relatively low. The Sendai-cocktail was given in order to protect the brain during temporary clipping of the carotid artery. The mean carotid stump pressure was 48mmHg. Though mild changes in SEP appeared in 21% of the patients, internal shunt was not used. The mean temporary clipping time was 36.6 minutes. There was no perioperative death, but perioperative neurological deficits appeared in 4 patients; one had a postoperative rupture of the carotid artery due to restlessness, one had carotid occlusion, and the other two showed motor weakness. In these 4 patients intraoperative monitorings showed no remarkable changes. A long-term follow-up study showed excellent condition in 23, mild disablement in 11, severe in 1, and death in 8 cases, in which 4 had heart disease. In 5 cases stroke recurred during the follow-up period, of which 3 had heart disease. From these results it was concluded that factors which worsened the postoperative courses after CEA were heart disease, failure in patient selection and poor operative technique.