Management of postendarterectomy neurologic deficits.

A series of 1,023 carotid endarterectomies were done between 1969 and 1980, with 31 patients (3.1%) having postendarterectomy neurologic deficits. Death ensued in seven patients (0.7%), and permanent neurologic deficits occurred in five patients (0.5%). Analysis of causes indicated that microemboli and thrombosis at the operative site are most frequent. When thrombosis is recognized early, this condition can be corrected by prompt reoperation. An algorithm can be used for guidance in management. Preventive measures include preoperative neurologic and cardiovascular stability that is maintained through the recovery period, meticulous operative dissection, and use of a temporary intraluminal shunt.