Perioperative Management for Carotid Endarterectomy, Making It Safer, Less Invasive and Surer

Abstract

We perform several contrives in perioperative management for carotid endarterectomy (CEA) to make it safer, less invasive and surer. We employ three-dimensional CT angiography (3D-CTA) as an alternative to conventional angiography, whose complications are up to 1.2% of all cases in ACAS (Asymptomatic Carotid Atherosclerosis Study). Patients with cardiovascular diseases and with diabetes mellitus should be referred to physicians for perioperative evaluation and management. Aged persons tend to present attenuated physiological function that prevents CEA, but this depends on individuals. Applying a shunt tube during CEA elicits fewer ischemic complications and a surer procedure, resulting in fewer embolic problems. We carry out SPECT study immediately after CEA to detect hyperemia, which may lead to hyperperfusion syndrome, and make every effort to avoid it from the early postoperative state.
However, the key to prevention of various perioperative complications of CEA lies in not only endeavors of individual neurosurgeons but in the achievement of general management as a medical team in cooperation with physicians and anesthesiologists.