Acta Neurochirurgica

, Volume 158, Issue 12, pp 2377–2383

Perioperative stroke after carotid endarterectomy: etiology and implications

  • Nicolas K. Khattar
  • Robert M. Friedlander
  • Rabih A. Chaer
  • Efthymios D. Avgerinos
  • Eric S. Kretz
  • Jeffrey R. Balzer
  • Donald J. Crammond
  • Miguel H. Habeych
  • Parthasarathy D. Thirumala
Clinical Article - Vascular

DOI: 10.1007/s00701-016-2966-2

Cite this article as:
Khattar, N.K., Friedlander, R.M., Chaer, R.A. et al. Acta Neurochir (2016) 158: 2377. doi:10.1007/s00701-016-2966-2
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Abstract

Background

Carotid endarterectomy (CEA) is the procedure of choice for reducing the risk of stroke in both symptomatic and asymptomatic carotid artery stenoses. Stroke is associated with significant morbidity and mortality peri-operatively (2–3 %). Our primary aim is to evaluate the etiology of these strokes after CEA and their impact on morbidity by comparing the length of stay in the hospital.

Methods

A total of 584 patients with documented neurological status evaluations who underwent CEAs were included in the study. Neurophysiological monitoring data was obtained during CEA for carotid stenosis included eight-channel electroencephalography (EEG) and upper extremity somatosensory evoked potentials (SSEPs).

Results

Twenty-one (3.595 %) patients had strokes in the perioperative period and they were more likely to have left-sided surgery (p = 0.008), intraoperative monitoring (IOM) changes (p < 0.001), an intraoperative shunt placed (p = 0.0002) or a hospital stay longer than 5 days (p = 0.0042). Unilateral anterior circulation ischemic stroke were the most common in our series. In a logistic regression model, left-sided surgery was shown to be 4.78 times more likely to be associated with perioperative stroke (1.50–15.27; p = 0.008) while intraoperative shunts were 11.85 times more likely to have strokes (3.97–35.34; p < 0.0001). Patients with stenosis greater than 70 % were 6.67 times less likely to have a stroke (0.04–0.59; p = 0.007).

Conclusions

Ischemic anterior circulation strokes are the most common type of post-operative neurological changes in patients undergoing CEA. Intraoperative shunt placement was a strong predictor of perioperative strokes. Since shunts are only placed following intraoperative monitoring changes, SSEPs and EEG can therefore function as a biomarker of cerebral hypo-perfusion.

Keywords

Perioperative stroke Carotid endarterectomy Etiology Length of stay 

Copyright information

© Springer-Verlag Wien 2016

Authors and Affiliations

  • Nicolas K. Khattar
    • 1
    • 2
  • Robert M. Friedlander
    • 1
  • Rabih A. Chaer
    • 3
  • Efthymios D. Avgerinos
    • 3
  • Eric S. Kretz
    • 1
  • Jeffrey R. Balzer
    • 1
  • Donald J. Crammond
    • 1
  • Miguel H. Habeych
    • 1
  • Parthasarathy D. Thirumala
    • 1
  1. 1.Department of Neurological SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Department of Neurological SurgeryUniversity of Louisville School of MedicineLouisvilleUSA
  3. 3.Department of Vascular SurgeryUniversity of Pittsburgh School of MedicinePittsburghUSA