INTERNAL CAROTID ENDARTERECTOMY UNDER LOCAL ANAESTHESIA

• Main Author: Andrej Šikovec
• Format: Article
• Language: English
• Published: Slovenian Medical Association 2004-12-01
• Series: Zdravniški Vestnik
• Subjects: internal carotid stenosis; endarterectomy; anaesthesia, local
• Online Access: http://vestnik.szd.si/index.php/ZdravVest/article/view/2392

<p>Background. Endarterectomy of the internal carotid artery, supported by medicamental treatment, is the best method used to prevent stroke with symptomatic patients with an over 70-percent narrowing of the ipsilateral carotid artery. With patients who have successfully passed the operation the occurrence of the stroke is less often than with non-operated patients (1% vs. 6–10% per year). Therefore, it is important that the operation is carried out as safely as possible. Currently, the average acceptable rate of death and/ or severe stroke risk stands at between 2–4%. Greatest problems faced during carotid artery surgery are embolism of the affected artery during preparation, brain ischaemia during the blockade of the carotid artery, and embolism and intimal tearing due to injury of the internal carotid artery by the temporary internal shunt. Due to the risk of causing an embolism and intimal tearing, the use of the internal shunt can be dangerous. Therefore, selective usage of the shunt is recommended when necessary due to brain ischaemia.</p><p>Methods. Under block/conduction anaesthesia (deep and superficial cervical block) we have performed surgery on 23 patients (16 males, 7 females) because of severe stenosis of the internal carotid artery (over 70%). A mixture of Xylocain 1% and Marcain 1.5% was used for the cervical block. Cerebral blood circulation was monitored by neurological testing of the patient awake during the procedure. During the procedure, we performed standard monitoring of the vital functions including the blood pressure. Additionally, the transcranial Doppler monitoring of the blood flow through the middle cerebral artery was used with 20 of the patients.</p><p>Results. Even after placing the artery clamp and cutting off the blood flow through the internal carotid artery no neurological deficits were observed with 18 patients, neither did we use temporary internal shunt with them. Five patients suffered problems with loss of consciousness, therefore we used the internal shunt. With all but one patient we performed a typical longitudinal endarterectomy and used the Dacron patch to close the carotid artery. Those patients underwent operation and post-operation treatment without complications and were dismissed from hospital five to seven days after the operation. Meanwhile, one patient’s condition worsened severely during preparation of the carotid artery even before the placement of the artery clamp, which resulted in paralysis on the contralateral side and loss of consciousness. The operation was suspended, the patient was treated conservatively.</p><p>Conclusions. The patients handled the procedure under block/ conduction anaesthesia well. Neurological testing of the patient awake during the procedure was a reliable method to ascertain cerebral blood circulation. Temporary internal shunt was used with patients who suffered a neurological deficit during the blockade of the carotid artery. As a result, the neurological deficit improved.<br /><br /></p>