Protocol of preventing perioperative strokes in reconstructions of carotid artery bifurcation

Beloyartsev D.F., Adyrkhaev Z.A.

Department of Vascular Surgery, Institute of Surgery named after A.V. Vishnevsky, Moscow, Russia

Presented herein is a protocol of preventing perioperative strokes in reconstructions of bifurcation of the carotid artery, used at the Department of Vascular Surgery of the Institute of Surgery named after A.V. Vishnevsky. The authors analysed the results of 630 primary carotid endarterectomies performed for atherosclerosis under general anaesthesia over the period from 2008 to 2010. Tolerance of the brain to carotid clamping was determined by measuring cerebral retrograde arterial pressure. Of the 630 operations, 65 (10.3%) interventions were carried out under temporal internal bypass. It was shown that the incidence rate of perioperative neurological complications among those tolerating carotid artery clamping was slightly lower than in the non-tolerating patients, with the incidence rate of strokes amounting to 1.8 and 3.1%, and that of “stroke + stroke-related mortality” amounting to 2.1 and 3.1%, respectively, but the differences were not statistically significant (p>0.5). Perioperative strokes in the absence of thrombosis of the reconstruction zone were observed in 0.6% of cases.

KEY WORDS: carotid endarterectomy, retrograde AP, temporal internal bypass, perioperative strokes.

P. 175

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