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We analyzed perioperative strokes in 658 carotid endarterectomies with the purpose of explaining the pathogenesis from the morphologic aspect of the infarct on cerebral computed tomograms.All endarterectomies were performed with continuous electroencephalographic monitoring.Of the 42 ischemic strokes(6.4%of all endarterectomies),34 could be studied.Seven infarcts were hemodynamically induced(five watershed infarcts,two patients with bilateral ischemia);all seven occurred during surgery.Twenty-three of the remaining 27 infarcts were within the territory of the middle cerebral artery(20)or anterior cerebral artery(three)and were probably of thromboembolic origin;13 of these 23 occurred during surgery(57%).If intraoperative stroke was heralded by permanent electroencephalographic changes,these were not related to the moment of cross-clamping.In four patients the computed tomogram was normal.We believe these facts favor the hypothesis that thromboembolism is the most important factor in the pathogenesis of perioperative stroke associated with carotid endarterectomy under conditions of optimal cerebral monitoring. |
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CAT scan
CAT scan,abnormal
CAT scan,false negative
cerebral embolism
cerebral infarction
cerebrovascular accident
cerebrovascular accident,bilateral
cerebrovascular accident,etiology
cerebrovascular accident,postoperative
embolism
endarterectomy,carotid
endarterectomy,carotid-complications of
endarterectomy,carotid-morbidity and mortality with
middle cerebral artery,emboli to
watershed infarcts
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