Carotid endarterectomy in awake patients: safety, tolerability and results

Revista Brasileira de Cirurgia Cardiovascular

Célio Teixeira Mendonça¹  Jerônimo A. Fortunato Jr¹  Cláudio A. De Carvalho¹  Janaina Weingartner¹  Otávio R. M. Filho¹  Felipe F. Rezende¹  Luciane P. Bertinato¹ 

关键词: Endarterectomy;    Carotid;    Anesthesia;    Local;    Stroke;    Endarterectomia das Carótidas;    Anestesia Local;    Acidente Vascular Cerebral;   

DOI  :  10.5935/1678-9741.20140053

来源: SciELO

【 摘 要 】

Objective: To analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch. Methods: One hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%). Results: A carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%). Conclusion: Carotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates.

【 授权许可】

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