Successful Management of Early Stroke After Carotid Endarterectomy

Abstract
The management of stroke occurring in the early postoperative period after successful carotid endarterectomy is discussed from experience in effectively reversing hemiplegia in 3 such consecutive patients. The value of instant reoperation is emphasized, and several factors that facilitate urgent reoperation were identified. These include omission of preoperative angiography, immediate reexploration under local anesthesia, and rapid restoration of cerebral flow by insertion of a shunt. Apparently reversal of neurological deficit in such patients can be accomplished if reoperation is carried out within 1 h of onset of stroke. All 3 patients managed by these criteria recovered and were neurologically intact 8-12 mo. later.