ROLE OF STAGING IN BILATERAL CAROTID ENDARTERECTOMY

  • 1 January 1978
    • journal article
    • research article
    • Vol. 84  (6) , 784-792
Abstract
Staging of bilateral carotid endarterectomies 1-6 wk apart was recommended because of presumed excessive morbidity chiefly related to respiratory problems, hypertension and neurological deficits. Since data regarding the timing of the second procedure are lacking, 79 patients undergoing bilateral endarterectomies staged from 6 days to 34 mo. apart (median interval, 52 days) were studied. In addition to examination for postoperative neurological deficits, transient perioperative mean systolic and diastolic blood pressures (SBP and DBP) from each side were compared and correlated with the time interval between the 2 procedures. No significant difference existed between the 2 sides in terms of preoperative hypertension, administration of steroids prior to clamping, intraoperative clamp time, the use of shunts and the duration of operation (P > 0.05). Seven temporary neurological deficits occurred after operation, 6 after the first and 1 after the second endarterectomy. One permanent deficit following operation on the second side led to the only death (0.6%) in this series. Both neurological deficits (1 temporary and 1 permanent) following the second endarterectomy occurred after procedures staged more than 60 days apart. No differences in mean SBP and DBP existed between patients with and without neurological deficits. Statistical analyses of SBP and DBP recordings during and 6, 12, 24 and 36 h after operation when the 2 were staged 7 days (9 patients), 8-14 days (5 patients), 15-30 days (10 patients), 30-60 days (17 patients) and more than 60 days (38 patients) apart, revealed significantly higher readings after the second procedure, only in patients staged > 60 days (P < 0.05). Neurological deficits were less common after the second endarterectomy, and, although postoperative blood pressures were higher after the second, these were significant only in patients staged more than 60 days apart. No evidence suggested that increasing the waiting period between bilateral procedures will lower the incidence of undesirable neurological sequelae.