What are the neurologic complications of carotid endarterectomy (CEA)?

Updated: Oct 24, 2019
  • Author: Sonia Nhieu, MD; Chief Editor: Sheela Pai Cole, MD  more...
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The majority of perioperative strokes occur during or within 12 hours after the surgical procedure. Ischemic strokes usually either are secondary to thrombosis or thromboembolism from the endarterectomy site or occur during intraoperative cross-clamping. [3]  

A hemorrhagic stroke after CEA is rare and is seen after repair of a critical stenosis in the presence of a distal infarct in a hypertensive patient. [3, 9]  Other risk factors for intracerebral hemorrhage after CEA include the following [2] :

  • Advanced age
  • Poor collateral flow
  • Slow flow in the middle cerebral artery territory

Of the 1415 surgical patients enrolled in NASCET, only two suffered postoperative intracerebral hemorrhages. [6]

Increased cerebral blood flow (CBF) to a previously underperfused territory can cause the phenomenon known as hyperperfusion syndrome, the symptoms of which include unilateral headache and altered mental status. Cerebral autoregulation is substantially impaired in the chronically hypoperfused territory; cerebral hyperperfusion from increased CBF, besides causing hemorrhagic strokes, can lead to brain edema, resulting in seizures. [2]

Strict control of BP in the postoperative period can prevent or limit the severity of hyperperfusion syndrome and thus reduce the incidence of neurologic complications and death. [2, 10]

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