Surgical Outcomes for Cervical Carotid Artery Stenosis: Treatment Strategy for Bilateral Cervical Carotid Artery Stenosis

Hokari, Masaaki; Nakayama, Naoki; Kazumata, Ken; Osanai, Toshiya; Nakamura, Toshitaka; Yasuda, Hiroshi; Ushikoshi, Satoshi; Shichinohe, Hideo; Abumiya, Takeo; Kuroda, Satoshi; Houkin, Kiyohiro

doi:10.1016/j.jstrokecerebrovasdis.2015.03.052

Cited by 3 publications

(1 citation statement)

References 33 publications

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“… 1 , 2 This was also confirmed by a 2015 study that showed that the existence of a contralateral occlusion or stenosis was not associated with peri-operative complications. 10 …”

Section: Discussionmentioning

confidence: 99%

Peri-operative Monitoring of an Asystolic Cardiac Arrest Requiring Cardiopulmonary Resuscitation During Carotid Endarterectomy for Symptomatic Carotid Artery Stenosis

Blok

Huizing

Kurvers

et al. 2021

EJVES Vascular Forum

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Introduction A carotid endarterectomy (CEA) has certain risks, of which peri-operative cardiovascular risk is one. Peri-operative neurological monitoring can be done with electroencephalography (EEG) and transcranial Doppler (TCD). No previous reports have been published demonstrating the actual changes in cerebral and cardiac activity during a peri-operative asystole. Report The case of a 70 year old man with a symptomatic (bilateral) carotid stenosis is described. The patient complained of amaurosis fugax in both eyes. Duplex ultrasound showed a stenosis of >70% in both carotid arteries. The most severe symptoms were on the right side, so a staged approach was chosen, starting with a right sided eversion CEA (eCEA). Peri-operatively, the patient experienced an asystolic cardiac arrest after external carotid artery revascularisation, requiring brief cardiopulmonary resuscitation, which was recorded on the EEG. Post-operatively, the patient recovered fully, with no post-operative neurological or cardiac sequelae. The (symptomatic) contralateral stenosis was treated conservatively with best medical therapy (BMT; dual antiplatelets and statin). The patient is currently in good clinical condition, 1.5 years later. Conclusion This case shows the unique EEG recording of a cardiological event during eCEA. The cause of asystole was most likely a vasovagal syncope as a result of the surgical procedure by iatrogenic damage to the carotid sinus fibres, causing impairment of the baroreflex and chemoreflex mechanisms, which is greater during eCEA. The unilateral eCEA and contralateral BMT in this symptomatic (bilateral) stenosis seemed appropriate when cardiological risk was increased but follow up ruled out any cardiological cause.

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“… 1 , 2 This was also confirmed by a 2015 study that showed that the existence of a contralateral occlusion or stenosis was not associated with peri-operative complications. 10 …”

Section: Discussionmentioning

confidence: 99%