What are the key considerations in the management of complications from carotid endarterectomy (CEA)?

Updated: Oct 24, 2019
  • Author: Sonia Nhieu, MD; Chief Editor: Sheela Pai Cole, MD  more...
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Answer

Answer

Key considerations in the management of postoperative complications of CEA include the following:

  • Surgical CEA is indicated in patients with severe (70-99%) carotid stenosis who are symptomatic with transient ischemic attacks (TIAs) or a nondisabling stroke and is three times as effective as medical therapy alone in reducing the incidence of stroke
  • CEA in patients with symptomatic moderate (50-60%) carotid stenosis yields only a moderate reduction in the risk of stroke; the decision between operative and medical therapy in these patients must take into account comorbidities and risk factors
  • Hypertension is the most powerful yet treatable risk factor for postoperative stroke; careful control of blood pressure (BP) after CEA prevents cerebral hyperperfusion, weakening of the arteriotomy site, and impairment of cardiac function
  • Ensuring hemostasis during wound closure reduces the risk of a postoperative wound hematoma
  • In a time-sensitive critical situation when there is impending respiratory compromise or airway loss, opening the surgical incision to decompress the trachea and thereby facilitate airway management should always be considered.
  • Urgent procedures and return to the operating room (OR) for a neurologic event or bleeding are associated with an increased risk of CN injury after CEA; however, given that the incidence of a permanent deficit is so low, the risk of CN injuries does not outweigh the benefit of stroke prevention after CEA

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