الفهرس يوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Carotid end arterectomy is prophylactic operation involving removal of an atheromtous lesion of the carotid artery that is likely to lead to future stroke if left alone. However, patients who might benefit from carotid endarterectomy also have coronary artery disease and the operation carries a significant morbidity and mortality from stroke and myocardial infarction. Therefore, risk-benefit analysis is important in the treatment of these patients to enable selection of them likely to benefit from surgery.
Patient selection has been an area of controversy for many years, but has been clarified with the publication of large multicentre trials into the efficacy of carotid endarterectomy in patients with both symptomatic and asymptomatic carotid artery disease.
Controversy still exists in the selection of the optimal method of anaesthesia. Of prime concern during carotid end arterectomy is protection of brain during carotid cross-clamping. Cerebral protection implies the use of prophylactic measures, prior to the onset of ischaemia, with the aim of reducing incidence the incidence of post-operative neurological deficit. Attempts at cerebral protection during CEA have largely depended on mechanical intervention aimed at rapidly restoring blood flow (shunt).