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Aim: To assess the procedural risk of carotid endarterectomy (CEA) in relation to its timing after ischemic stroke and to define the reasons that delay surgery beyond the recommended time interval. Materials and methods: A retrospective analysis was performed using prospectively collected data from all consecutive patients with symptomatic internal carotid artery stenosis who underwent CEA during the period from January 2013 to August 2019. The patients were divided into four groups according to the timing of CEA: group 1 – CEA within 2 days; group 2 – CEA between 3–7 days; group 3 – CEA between 8–14 days; and group 4 – CEA between 15–180 days. The primary outcome measure was the combined perioperative rate of any stroke or death within 30 days. Results: A total of 246 patients were included in the study. The median time interval between stroke and CEA was 8 days. A total of 191 patients (77.6%) underwent CEA within the recommended 14-day period from ischemic stroke, whereas 55 patients (22.4%) underwent CEA more than 14 days after stroke. Medical reasons were the cause of CEA delay in only 18 out of these 55 patients. For the entire cohort, the overall 30-day rate of any stroke or death was 3.7% (9 patients out of 246). The procedural risk was 5.9% (3 patients out of 51) in group 1, 1.5% (1 patient of 68) in group 2, 5.6% (4 patients out of 72) in group 3, and 1.8% (1 patient out of 55) in group 4 (P = 0.477). Conclusion: In this study, the time interval between the stroke and CEA was not associated with significant increase of procedural risk of any stroke or death. [ABSTRACT FROM AUTHOR]

Aim: The influence of antiplatelet agents and anticoagulants on hemorrhagic complications and the development of ischaemic brain lesions during carotid endarterectomies (CEAs) was studied. Methods: During 559 CEAs antithrombotic therapy, as administrated by a referral doctor, was kept. The influence of antithrombotic therapy on the: 1. incidence of wound hematoma; 2. incidence of symptomatic intracerebral hematoma after CEA; 3. length of hospital stay; 4. incidence of new brain ischaemic lesions were studied. Results: In total, wound hematoma was found in 43 (7.69%) cases. Of those there were: 1. 2.94% in „no antithrombotic” group; 2. 5.18% (p = 0.55) in the acetylsalicylic acid (ASA)/ASA + derivates group; 3. 18.36% (p = 0.008) in clopidogrel group; 4. 0% in ticlopidin group; 5. 20% = 0.022) in low molecular weight heparin (LMWH) group; 6. 19.05% (p = 0.026) in LMWH + ASA group; 7. 36,36% (p = 0.003) in clopidogrel + ASA group. Incidence of symptomatic intracerebral hematoma after CEA was 0.89% in five cases. The mean length of hospital stay was 4.7 days for uncomplicated cases, 5.1 days for cases with hematoma without reoperation and 7.2 days for cases with hematoma with reoperation. Incidence of new ischaemic lesions after CEA was 10.91%, not related to antithrombotic therapy (p > 0.18). Conclusion: Clopidogrel, LMWH and LMWH + ASA groups showed app. 4 times higher risk of wound hematoma, dual antiplatelet therapy 5.5 times higher compared to ASA therapy only. Therefore, their use preoperatively in CEA should be restricted for cases of symptomatic stenosis with high recurrent risk of stroke. No influence of antithrombotics on the incidence of new ischaemic brain lesions dur i ng CEA was showed. Práca [ABSTRACT FROM AUTHOR]

Many physiological functions including cognition are decreasing with ageing. Cognitive function reduction disturbing functioning in activities of daily living is called dementia. In seniors, performing a cognitive assessment using short screening instruments is strongly recommended during preoperative evaluation. In the case report I describe a case of an 80-year old lady with bilateral carotid stenoses resulting in insufficient brain oxygen delivery with pathologically low rSO2 values on near infrared spectroscopy (NIRS) and decreased cognitive performance. She underwent carotid endarterectomy on both sides. With oxygen inhalation during the surgery, these very low rSO2 values normalized completely so that introducing shunts was unnecessary during carotid clamping. Would such brain hypoxia be an indication for longer oxygen therapy? Brain hypoxia before the first surgery could be explained by decreased cerebral blood flow caused by carotid stenoses, because rSO2 values as well as cognitive functioning using Clock-In-the-Box test improved significantly after the endarterectomy. Short cognitive assessment during preoperative evaluation is feasible and with NIRS monitoring in carotid surgery it can facilitate perioperative management and make risk assessment easier. [ABSTRACT FROM AUTHOR]

Carotid endarterectomy (CEA) is a standard treatment of serious symptomatic or asymptomatic stenoses of carotid arteries. It is a prophylactic operation performed more to reduce the risk of embolic stroke from atheromatous disease at the carotid bifurcation than to relieve the hemodynamic stenosis. The risk is reduced by 50% but the benefit can be realized only if the risks of operation and associated anaesthesia are lower than the achieved reduction of the risk of stroke. The most feared complications are death and peri-operative stroke. Myocardial infarction can occur as well. An important adverse event is also a cerebral hyper-perfusion syndrome. CEA can be carried under general, regional (cervical epidural blockade or superficial, intermediate or deep cervical block or their combinations) or local infiltration anaesthesia. Each anaesthetic technique must provide sufficient ventilation and oxygenation, cardiovascular stability and free cerebral venous drainage. It must also allow shunt insertion based on the sufficiency of cerebral perfusion. This can be accomplished by clinical neurological assessment (in awake patients) and/or by technical devices. Unfortunately, they do not have satisfactory sensitivity or specificity. Based on the studies performed, the safest techniques are general anaesthesia with selective shunting determined by cerebral perfusion monitoring or superficial and/or intermediate cervical block. Regional anaesthesia seems more economical. [ABSTRACT FROM AUTHOR]

Objective: To assess the reliability and safety of ultrasound guided medial cervical plexus blockade. Design: Prospective observational study. Setting: Department of Anesthesiology and Critical Care, Regional Tertiary Hospital. Materials and methods: We studied 50 ASA II-III patients (28 males and 22 females, average age 62 years) undergoing carotid endarterectomy. Medial cervical plexus blockade was performed under ultrasound guidance using „in plane" technique. We injected 20 mL of 0.375% bupivacaine in between the fasciae dividing the sternocleidomastoid and levator scapulae muscles. All patients received 100 mcg of intravenous fentanyl after block administration. We documented the incidence of satisfactory blockade for carotid artery surgery, the need for supplementary infiltrative local anaesthesia with 1% trimecaine, the need for conversion to general anaesthesia and the complication rate. Results: Medial cervical block without any supplementary local anaesthesia was achieved in 32 (64%) patients. Supplementary infiltration of local anaesthetic into the operative area was required in 17 (34%) patients. Only one patient required repeated local anaesthetic supplementation. Conclusion: Conversion to general anaesthesia was not necessary in any of our patients. The following complications were encountered: transient unilateral recurrent nerve block in two patients and transient phrenic nerve block in one case. [ABSTRACT FROM AUTHOR]

Carotid endarterectomy is one of the most frequent vascular surgery procedures worldwide. The postoperative course is mostly uncomplicated. Neurological complications may manifest as a cerebral stroke, hyperperfusion syndrome or, rarely, as convulsions. Postoperative cardiovascular instability that may occur includes hypertension or less often hypotension and cardiac dysrhythmias. Acute myocardial ischaemia is seen mostly in patients with ischaemic heart disease. Other complications include postoperative wound haematoma potentially leading to airway obstruction and damage to the nerves adjacent to the surgical incision. [ABSTRACT FROM AUTHOR]