Operative details
Preoperative evaluation has been already described in previously
published papers of this collaborative group.14,15Specifically for this study, indications for CEA are consistent with the
guidelines for the management of extra-cranial carotid disease of the
Society for Vascular Surgery (SVS).11 Single stage CVS
and CEA intervention was considered reasonable in patients:
- with severe and/or symptomatic coronary/valve disease that cannot be
emended by endovascular means or exposed to a high-risk of
perioperative cardiac complications
- with ≥50-99% carotid stenosis with a history of stroke or transient
ischemic attack (TIA) in the preceding 6-months
- with bilateral asymptomatic 70-99% carotid stenosis
- with unilateral asymptomatic 70-99% stenosis and contralateral
occlusion.
All the interventions were performed under general anesthesia,
antibiotic prophylaxis and heparinization. Intraoperatively,
somatosensory-evoked potentials plus electroencephalogram, or
transcranial-Doppler was used to monitor cerebral status during surgical
intervention, and to indicate when the use of shunt was necessary.
Carotid endarterectomy was performed using a standard longitudinal
arteriotomy; eversion technique was never used. Patch closure was used
in selected patients, based on a combination of factors such as gender,
size of internal carotid artery, and distal extension of the plaque.
Skin incision was closed after the patient was out of extracorporeal
circulation. Immediate neurologic assessment of the patient was
accomplished upon awakening, and throughout the entire postoperative
course if necessary. Any sudden suspect neurologic deficit was promptly
evaluated with the collaboration of an independent neurologist, and with
computed tomography to determine the etiologic mechanism, and to guide
subsequent treatment.