Operative details
Preoperative evaluation has been already described in previously published papers of this collaborative group.14,15Specifically for this study, indications for CEA are consistent with the guidelines for the management of extra-cranial carotid disease of the Society for Vascular Surgery (SVS).11 Single stage CVS and CEA intervention was considered reasonable in patients:
All the interventions were performed under general anesthesia, antibiotic prophylaxis and heparinization. Intraoperatively, somatosensory-evoked potentials plus electroencephalogram, or transcranial-Doppler was used to monitor cerebral status during surgical intervention, and to indicate when the use of shunt was necessary. Carotid endarterectomy was performed using a standard longitudinal arteriotomy; eversion technique was never used. Patch closure was used in selected patients, based on a combination of factors such as gender, size of internal carotid artery, and distal extension of the plaque. Skin incision was closed after the patient was out of extracorporeal circulation. Immediate neurologic assessment of the patient was accomplished upon awakening, and throughout the entire postoperative course if necessary. Any sudden suspect neurologic deficit was promptly evaluated with the collaboration of an independent neurologist, and with computed tomography to determine the etiologic mechanism, and to guide subsequent treatment.