Prevention of neurologic complications of carotid endarterectomy.

We studied the neurologic complications after carotid endarterectomy to develop recommendations for prevention. From 1973 through June 1981, 195 carotid endarterectomies were performed on 184 patients. Carotid endarterectomy was performed using general anesthesia with routine use of a Javid shunt. There were no postoperative deaths. Three major, disabling strokes (1.5%) and four (2%) minor, permanent neurologic deficits occurred. The neurologic deficits were analyzed according to cause: (1) inadequate cranial inflow in four patients, (2) fluctuation in blood pressure requiring treatment in one third (61) of our patients, and (3) embolic complications, usually a single, transient ischemic episode, in 17 patients during the first postoperative week. This was not observed in patients receiving postoperative antiplatelet therapy. Inadequate collateral cerebral inflow accounts for most permanent postoperative neurologic deficits. Postoperative hypotension is now more dangerous than hypertension. Postoperative embolization is largely preventable with antiplatelet agents.