BACKGROUND:
Carotid lesions will often remain asymptomatic during the perioperative per
iod, so prophylactic carotid endarterectomy (CEA) has not been advocated be
fore other operations. The purpose of this study was to characterize the cl
inical manifestations of new neurologic symptoms occurring in patients with
previously asymptomatic carotid occlusive disease who have undergone recen
t operations.
STUDY DESIGN:
We performed a retrospective review of patients developing neurologic sympt
oms attributable to carotid occlusive disease after unrelated operations.
RESULTS:
Eleven patients (mean age 68 +/- 6.4 years, 8 men, 3 women) developed new n
eurologic symptoms from previously asymptomatic extracranial carotid stenos
es after 11 unrelated procedures. Neurologic events included hemispheric st
roke (n = 10) and amaurosis fugax (n = 1). Two intraoperative strokes occur
red (one mastectomy, one prostatectomy). Other events occurred a mean of 5.
8 +/- 5 (range 1 to 16) days after aortic surgery (n = 2), infrainguinal by
pass (n = 3), contralateral CEA for symptomatic disease (n = 2), incisional
herniorrhaphy (n = 1), and prostate surgery (n = 1). Responsible internal
carotid artery lesions were all stenoses greater than 80%; seven were dearl
y greater than 90%. Those suffering intraoperative stroke or stroke within
24 hours of operation (n = 3) were not receiving antithrombotic therapy. Al
l other events (n = 8) occurred despite the use of antiplatelet or anticoag
ulant agents. Four underwent emergent CEA. Four had elective CEA performed
after reaching a neurological recovery plateau.
CONCLUSIONS:
Critical, asymptomatic internal carotid artery stenoses may cause neurologi
c symptoms after unrelated surgical procedures. (J Am Coll Surg 2001;192:60
8-613. (C) 2001 by the American College of Surgeons).