OBJECTIVE: Because the clinical benefit of urgent investigation and carotid re-repair for acute @entity64 complicating carotid endarterectomy (CEA) is uncertain, the results of this approach were examined in a large series of @entity1 . METHODS: In a consecutive series of 700 CEAs, 24 @entity1 (3.4%) had a @entity64 . Thirteen of these 24 @entity1 experienced major @entity51 ( @entity1158 with or without @entity2026 , forced eye deviation, and decreased consciousness) that prompted either immediate surgical reexploration or cerebral angiography with reoperation on the basis of angiogram results; these 13 @entity1 are the subject of this report. Neurological improvement was attributed to carotid reopening when affected muscle strength increased to antigravity power within 6 hours of reoperation. RESULTS: Of the 13 @entity1 with severe @entity86 , 5 (38%) had the deficits when they awakened, 7 deficits occurred within 12 hours of surgery, and the only @entity1779 in this series occurred 8 days after surgery. Five @entity1 underwent urgent reoperation without angiography, and @entity432 were found and repaired in two @entity1 . In another @entity1 , the carotid was patent, and an intra-arterial injection of tissue plasminogen activator (20 mg) was given. In the seven @entity1 who underwent cerebral angiography as the first step, two @entity432 and one residual @entity850 with @entity715 were found and repaired on an urgent basis. Surgical reopening of occluded arteries was followed by improvement in two of four @entity1 , and early improvement was noted in one @entity1 with a @entity850 correction as well as in the @entity1 who received intraoperative tissue plasminogen activator. Four @entity1 who underwent urgent reoperation did not demonstrate a benefit soon after surgery. Two @entity1 died, two were left with major deficits and five with moderate deficits, and four @entity1 eventually had good recovery at a minimum of 6 months of follow-up. CONCLUSION: In this series, approximately one-half of hemispheric @entity64 complicating CEA had an underlying correctable lesion (occlusion or @entity850 ), and these @entity1 typically had delayed-onset @entity64 . Approximately one-half of these @entity1 improved early as a result of reopening, although computed tomography revealed new @entity1188 in most of them. Urgent carotid repair may benefit a minority of selected @entity1 who have a @entity64 after CEA.

Reoperation for acute XXXX after carotid endarterectomy: is there any value?

@entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity1158 :: ('MESH:D006429', 'Disease') :: ['hemiplegia'] @entity64 :: ('MESH:D020521', 'Disease') :: ['strokes', 'stroke', 'postoperative stroke', 'major stroke'] @entity51 :: ('MESH:D009461', 'Disease') :: ['hemispheric deficits'] @entity2026 :: ('MESH:D001037', 'Disease') :: ['aphasia'] @entity1188 :: ('MESH:D007238', 'Disease') :: ['infarcts'] @entity86 :: ('MESH:D019106', 'Disease') :: ['postoperative deficits'] @entity432 :: ('MESH:D001157', 'Disease') :: ['carotid occlusions'] @entity715 :: ('MESH:D013927', 'Disease') :: ['thrombus'] @entity850 :: ('MESH:D003251', 'Disease') :: ['stenosis'] @entity1779 :: ('MESH:D002543', 'Disease') :: ['intracerebral hemorrhage']
@entity64 :: (MESH:D020521,Disease) :: ['hemispheric stroke']
