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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

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Estimation of perioperative risk in carotid endarterectomy: A risk group classification

Perioperative Risikoabschätzung bei Karotisendarteriektomie: Risikogruppeneinteilung

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  • corresponding author Bernhard Rieger - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 Münster
  • S. Palkovic - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 Münster
  • F. T. Möllmann - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 Münster
  • J. Bergmann - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 Münster
  • B. Fischer - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 Münster
  • H. Wassmann - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, 48149 Münster

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocMO.03.08

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2004/04dgnc0042.shtml

Published: April 23, 2004

© 2004 Rieger et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

According to NASCET- and ECST-study carotid endarterectomy (CEA) reduces the risk of stroke in patients with symptomatic severe carotid stenosis. However there is still a risk of perioperative complications of about 5%. We tried to identify defined risk groups for perioperative ischemic incidents in our patients whose multilocular vascular pathology necessitated a neurosurgical intervention to avoid perioperative stroke.

Methods

Two hundred and eighteen CEAs were performed in 208 patients either uni - or bilaterally. In order to find a potential risk profile, patients were devided into groups with and without perioperative ischemic incident. To ascertain whether incident of risk factors were accidental or based on certain risk criteria, statistical analysis was performed with the Chiquadrat Test and the Jonckheere -Terpstra Test.

Results

Ten patients suffered a perioperative ischemic event (4.8%). Rates for individual complications were as follows: Non disabling stroke, 4 patients (1.9%); major stroke, 4 patients (1.9%); amaurosis, 2 patients (1.0%).The statistical analysis showed an increased risk for ipsilateral stroke (p?0.001) by contralateral occlusion or high grade stenosis, more profoundly clinical symptom status before the operation (major strokes, minor strokes, transient ischemic attack), and by the existence of numerous risk factors for arteriosclerosis. All patients with perioperative complications belonged to the high risk group.

Conclusions

The existence of predictive factors for the appearance of perioperative ischemic incidents in candidates for CEA will help to identify patients with a pronounced risk of perioperative complications; these should be operated on using meticulous policy such as microsurgical technique, intraoperative monitoring and neuroprotective measures.