Rojas-Reyna GA, Kleriga E, Cervantes J, Stoopen E, Ochoa R, Valdés J, Collado-Corona MA, Álvarez-Reséndiz G

Language: Spanish
References: 37
Page: 249-254
PDF size: 98.85 Kb.

ABSTRACT

Introduction: It was considered advisable to review the theme and the casuistry of 12 years by the authors in patients with cerebral infarct due to carotid disease, due to the high morbility and mortality as well as the frequency of incapacitating sequels. Material and method: From June 1988 to June 2000 at the ABC Hospital in Mexico City, 63 patients (33 female and 30 male) with a mean age of 70 years required 68 carotid endarterectomies. Their main risk factors were arterial hypertension 40 patients (63%), smoking 40 (63%), ischemic heart disease 22 (35%), pneumopathy 12 (19%), and diabetes mellitus 10 (16%). Of the 68 endarterectomies, 40 were left and 28 right, 61 for symptomatic stenosis and seven, asymptomatic. Their main symptoms were transient ischemic attacks 39 (63.9%), previous stroke 13 (21.31%), and amaurosis fugax nine (14.75%). The average percentage of carotid stenosis was for symptomatic lesions 86.47%, and for asymptomatic, 82%. Results: All patients were operated on under general-endotracheal anesthesia, with pharmacologic cerebral protection, and electroencephalographic and somato-sensory evoked potential monitorization. Nine cases (13.23%) required a shunt. The mean carotid clamping time was, for the patients without shunt 35.8 min and 4 min with shunt. Seven cases (10.29%), all females, needed arteriorraphy with patch angioplasty: four dacron; two PTFE, and one saphenous vein. The mean operating time was 2 h 37 min. Operative mortality was one case (1.47%) from ventricular fibrillation secondary to acute MI, central neurologic morbidity, and one case (1.47%), peripheral neurologic morbidity, two cases (2.94%) due to neuropraxic lesion of the recurrent laryngeal and facial nerves with complete recovery. Non-neurologic morbidity was nine cases (13.23%): postoperative HTN four; pos-operative arterial hypotension three hematoma, one and acute MI, 1. The average hospitalization time was 4.52 days. Discussion: The results of this series of carotid endarterectomies with patients whose average age in the eighth decade of life, in which 47% of patients were classified as ASA III, of which 89.7% had an average of 86.4% symptomatic stenosis showed low operative mortality and low central neurologic morbidity, to comparable results from the NASCET and ACAS.

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