Successful management of early stroke after carotid endarterectomy.

This paper concerns the management of stroke coming on in the early postoperative period after successful carotid endarterectomy. Our experience in effectively reversing hemiplegia in three such consecutive patients forms the basis of this report. The value of instant reoperation is emphasized, and several factors that facilitate urgent reoperation have been identified. These include omission of preoperative angiography, immediate reexploration under local anesthesia, and rapid restoration of cerebral flow by insertion of a shunt. Our experience would indicate that reversal of neurological deficit in such patients can be accomplished if reoperation is carried out within one hour of onset of stroke. All three patients managed by these criteria recovered and were neurologically intact eight to twelve months later. These results are in contrast to the failure to reverse stroke noted by us and others when the above measures were not followed.