Internal carotid artery (ICA) occlusion has long been thought to carry a poor prognosis despite what is often an asymptomatic presentation. However, increasing recognition of segmentation based on cerebrovascular imaging and/or perfusion monitoring techniques, clinical status of initial presentations, and…
Sudden fluctuations in heart rate and blood pressure are common among patients undergoing a wide variety of surgical procedures. Although the etiology of hemodynamic instability is multifactorial, this phenomenon is most commonly encountered among patients with preexisting cardiovascular disease and/or…
A diagnosis of an occluded or nearly occluded carotid artery is anxiety provoking for the patient. In these cases, referring physicians often request urgent if not emergent vascular consultation. Because large randomized trials regarding these conditions do not exist, best…
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Stroke is the third leading cause of death and the most common cause of long-term neurologic disability worldwide. Each year, 795,000 Americans suffer a stroke, of which 80% are ischemic. Carotid atherosclerotic disease is implicated in 15% to 30% of…
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Stroke complicating carotid endarterectomy (CEA) is broadly classified into intraoperative or postoperative. Such a classification has implications for the likely etiology and type of stroke and indication for exploration or neurorescue maneuvers; it also affects prognosis. An intraoperative stroke is…
Neurologic complications during the performance of carotid endarterectomy (CEA) are most commonly caused by embolization from the area of the carotid bifurcation or a result of hypoperfusion from inadequate collateral blood flow during carotid clamping. The recognition of intraoperative cerebral…
Improving the results of carotid endarterectomy (CEA) through technical excellence will likely further establish the known effectiveness of the procedure. Technical errors, which can lead to perioperative stroke, include arterial strictures, intraluminal thrombi, intimal flaps, and arterial kinks. These defects…
Temporary clamping of the internal carotid during carotid endarterectomy (CEA) interrupts antegrade blood flow to the brain in the distribution of the ipsilateral middle and anterior cerebral artery. The consequence of clamping the internal carotid artery is of critical importance…