Correlation of neurologic complications and pressure measurements during carotid endarterectomy.

There was no significant difference between the mean occluded internal carotid artery pressure in asymptomatic, transient ischemic attack or prior stroke patients. The stump pressure was not consistently elevated at the second operation in those having undergone bilateral procedures. Estimate of back bleeding from the internal carotid artery operation did not necessarily correlate with the stump pressure. Adequate back bleeding was recorded in patients with a low stump pressure, and reduced bleeding was noted in individuals with a high stump pressure. The pressure gradient across the stenosis of the bifurcation of the carotid artery was helpful in assessing the degree of stenosis present. The occluded internal carotid artery pressure seemed to be a helpful aid in indicating those patients with poor collateral flow and, therefore, at high risk of ischemic brain damage. The use of an inlying shunt in those individuals having a low stump pressure may be expected to reduce the over-all neurologic complication rate in patients undergoing carotid endarterectomy.