Endarterectomia de carótida em paciente acordado

Santos, Paulo César; Fabri, Hélio Antônio; Cunha, Claúdio Ribeiro da; Martins, Carlos Alberto da Cunha; Shinosaki, Jullyanna Sabrysna Morais; Neves, Adriano Silva; Queiroz, Olair A; Rodrigues, Adriano Rogério Baldacin

doi:10.1590/s0102-76382006000100012

Cited by 2 publications

(3 citation statements)

References 19 publications

(48 reference statements)

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“…The main reason why loco-regional anesthesia is preferred in our service, in spite of general anesthesia, is the fact that we can observe the neurological status of the patient during carotid artery crossclamping [ 14 ] . The fact that a small but significant group of patients will present intolerance during crossclamping of the internal carotid artery, and consequently require the carotid shunt for cerebral protection during endarterectomy, causes a serious dilemma for surgeons who choose to perform this surgery using general anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…Lawrence et al [ 19 ] demonstrated that the incidence in the use of shunts in patients operated under loco-regional anesthesia was approximately 4.5%, a result comparable to our study (incidence in the use of shunt of 2.4%). As the routine use of a carotid shunt may lead to an incidence of up to 3% of iatrogenic complications (such as embolization of air or cholesterol particles to the brain, and lesions of the carotid intima causing early thrombosis and late stenosis) [ 14 ] , we opted for its selective use in our service.…”

Section: Discussionmentioning

confidence: 99%

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Carotid endarterectomy in the awake patient: safety, tolerability and results

Mendonça¹,

Fortunato²,

Carvalho³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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ObjectiveTo analyze the results of 125 carotid endarterectomies under loco-regional anesthesia, with selective use of shunt and bovine pericardium patch.MethodsOne hundred and seventeen patients with stenosis ≥ 70% in the internal carotid artery on duplex-scan + arteriography or magnetic resonance angiography underwent 125 carotid endarterectomies. Intraoperative pharmacological cerebral protection included intravenous administration of alfentanil and dexametasone. Clopidogrel, aspirin and statins were used in all cases. Seventy-seven patients were males (65.8%). Mean age was 70.8 years, ranging from 48 to 88 years. Surgery was performed to treat symptomatic stenosis in 69 arteries (55.2%) and asymptomatic stenosis in 56 arteries (44.8%).ResultsA carotid shunt was used in 3 cases (2.4%) due to signs and symptoms of cerebral ischemia after carotid artery clamping during the operation, and all 3 patients had a good outcome. Bovine pericardium patch was used in 71 arteries ≤ 6 mm in diameter (56.8%). Perioperative mortality was 0.8%: one patient died from a myocardial infarction. Two patients (1.6%) had minor ipsilateral strokes with good recovery, and 2 patients (1.6%) had non-fatal myocardial infarctions with good recovery. The mean follow-up period was 32 months. In the late postoperative period, there was restenosis in only three arteries (2.4%).ConclusionCarotid artery endarterectomy can be safely performed in the awake patient, with low morbidity and mortality rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Carotid endarterectomy in the awake patient: safety, tolerability and results

Mendonça¹,

Fortunato²,

Carvalho³

et al. 2014

Revista Brasileira De Cirurgia Cardiovascular

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“…Thus, the possible increased risk for neurological events is extrapolated from series of patients undergoing CABG and who have obstructive atherosclerotic disease in the internal carotid artery, subjected the brain low flow in the pre-and postoperative period. In these patients, endarterectomy performed simultaneously [3], or even preceding [4] CABG is associated with low incidence of neurological events. The present patient had significant stenosis (approximately 80%) at the origin of the LCCA and BTC associated with stenosis of the left internal carotid artery but no symptoms related to these obstructions were observed.…”

Section: Discussionmentioning

confidence: 99%

Revascularização simultânea do miocárdio e dos troncos supra-aórticos

Cunha¹,

Santos²,

Atik³

et al. 2012

Rev Bras Cir Cardiovasc

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We report the case of a 58-year-old patient, with a three vessel disease with unstable angina. Due to refractory angina, she was referred to urgent coronary artery bypass graft (CABG). In the preoperative evaluation were found severe obstructive lesions in the brachiocephalic trunk origin, left common carotid origin and left internal carotid artery. The patient underwent CABG, supra-aortic trunks revascularization (extraanatomic bypass) and carotid endarterectomy in the same procedure. She presented an uneventful recovery and was discharged home on the seventh postoperative day. Currently, two years after the procedure, she continues under follow-up, symptomless. Descriptors:Angina

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Endarterectomia de carótida em paciente acordado

Cited by 2 publications

References 19 publications

Carotid endarterectomy in the awake patient: safety, tolerability and results

Carotid endarterectomy in the awake patient: safety, tolerability and results

Revascularização simultânea do miocárdio e dos troncos supra-aórticos

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