SEIZURES FOLLOWING CAROTID ENDARTERECTOMY IN PATIENTS WITH SEVERELY COMPROMISED CEREBRAL-CIRCULATION

Objectives: To determine the incidence of postoperative neurological complications following carotid endarterectomy in patients with severely compromised cerebral circulation. Design: Prospective open clinical study. Setting: Department of Vascular Surgery, University Hospital. Materials and Methods: We determined the incidence of postendarterectomy seizures related to haemodynamic impairment in terms of intraoperatively measured perfusion pressure in 151 patients undergoing 153 carotid endarterectomies. Main Results: Cerebral perfusion pressure index (ICA/CCA pressure ratio) was significantly reduced (25% or more) in 47% (55/118) of patients with 70-99% stenosis compared to 6% (2/35) of patients with 30-69% stenosis (p < 0.00005). Among the 57 haemodynamically compromised patients five developed seizures considered due to cerebral hyperperfusion five to seven days after surgery. The seizures were associated with headache in two, focal neurological deficits in four and hypertensive episodes in all cases. The symptoms remitted within 2 weeks and no patients suffered cerebral haemorrhage. Conclusions: Seizures following correction of high grade stenoses causing severe pressure reduction my be more common than previously assumed. Patients at risk should be identified and postoperative blood pressure controlled meticulously.