Management options for post carotid endarterectomy stroke.

BACKGROUND

Management of acute thrombosis of the carotid artery has been controversial. This retrospective study reviews the etiology and analyzes the management options of post carotid endarterectomy stroke.

METHODS

Diagnosis was made using oculopneumop-lethysmography (OPG/Gee), duplex ultrasound, computed tomography (CT) scanning, and carotid exploration.

RESULTS

The cause of stroke was identified as carotid thrombosis in 19/32 patients (59%) and non-carotid thrombosis in 13. Management options included nine patients who underwent selective carotid exploration and all had a thrombosed carotid; mandatory exploration-six were explored and three had a thrombosed carotid artery; and 17 patients had no exploration (medical treatment). Fourteen patients had a positive OPG, 13 were confirmed to have carotid thrombosis. Eight patients had a negative OPG and all were confirmed. The OPG had an overall accuracy of 95% in detecting postoperative thrombosis (89% specificity and 100% sensitivity). Patients with thrombosed carotids and patients with positive OPGs had more severe neurological deficits than those with non-thrombosed carotids. The final neurological status of the 12 patients with carotid thrombosis who underwent thrombectomy and patch angioplasty was improved (7/12) in contrast to the seven patients who did not undergo a thrombectomy (1/7). Seven of nine patients had a complete or good recovery when thrombectomy was done within two hours of the stroke in contrast to 0/3 after two hours. Seven of ten patients with Grade II stroke (moderate) had a good recovery after carotid exploration and thrombectomy in contrast to 0/2 for Grade III (severe) stroke.

CONCLUSIONS

Carotid artery thrombosis, the most common cause of post carotid endarterectomy stroke, can be detected by OPG/Gee. Immediate carotid exploration for patients with Grade I or II strokes, when thrombosis is demonstrated, can improve the results of carotid endarterectomy.