Chapter 23 Carotid Endarterectomy

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What is the most common cause of postoperative stroke after carotid endarterectomy (CEA)?

Tension pneumothorax

Development of an incisional hematoma

Neurologic deficits during initial assessment

Thrombus formation and embolization of plaque debris (correct)

What is the immediate intervention after a significant incisional hematoma is discovered post CEA?

Notification of the surgeon to evacuate the hematoma (correct)

Relieving the pressure on the structures of the neck

Airway management

Immediate re-exploration of the surgical site

What might contralateral asymmetry in a patient's smile indicate after carotid endarterectomy?

Facial nerve damage (correct)

Spinal accessory nerve damage

Glossopharyngeal nerve damage

Vagus nerve damage

Which cranial nerve controls the pharyngeal muscles and the ability to swallow?

Glossopharyngeal nerve (IX) Signup and view all the answers

Unilateral damage to which laryngeal nerve can cause hoarseness?

Internal branch of the superior laryngeal nerve Signup and view all the answers

Which cranial nerve controls the sternocleidomastoid and trapezius muscles?

Spinal accessory nerve (XI) Signup and view all the answers

Which nerve is responsible for control of the muscles of the tongue?

Hypoglossal nerve (XII) Signup and view all the answers

What is the formula for cerebral perfusion pressure (CPP)?

MAP - ICP Signup and view all the answers

What shifts the autoregulation curve to the right in patients with hypertension?

Higher perfusion pressures Signup and view all the answers

What is the normal range for cerebral metabolic requirements for oxygen (CMRO2)?

3.0 to 3.8 mL O2/100 g brain tissue/minute Signup and view all the answers

What is the effect of hyperthermia on cerebral metabolic requirements for oxygen (CMRO2)?

Increases CMRO2 Signup and view all the answers

What is the recommended carotid artery stenosis percentage for symptomatic patients to undergo carotid endarterectomy?

Greater than 70% Signup and view all the answers

What is the estimated prevalence of carotid artery stenosis in individuals over the age of 80?

10% Signup and view all the answers

Which vessels are responsible for supplying 80% to 90% of the blood to the brain?

Internal carotid arteries Signup and view all the answers

What is normally autoregulated over a range of mean arterial pressures from 60 to 150 mm Hg?

Cerebral blood flow Signup and view all the answers

What results in a predictable pattern of neurologic symptoms specific to the area of the brain supplied by the vessel?

Occlusion of a major cerebral vessel Signup and view all the answers

What is the recommendation for symptomatic patients with carotid artery stenosis of less than 30%?

Continued medical management Signup and view all the answers

What is a risk factor for postoperative hypertension after carotid endarterectomy (CEA)?

Preoperative systolic blood pressure > 180 mm Hg Signup and view all the answers

What is the main concern regarding patients with severe hypertension undergoing surgical correction?

Increased risk of postoperative stroke Signup and view all the answers

What is the leading cause of mortality after carotid endarterectomy (CEA)?

Postoperative myocardial infarction Signup and view all the answers

What should be assessed in the preoperative evaluation of patients undergoing carotid endarterectomy (CEA) due to the high risk of neurologic events?

Pulmonary function and smoking history Signup and view all the answers

What is the main advantage of utilizing regional anesthesia for carotid endarterectomy (CEA)?

Improved cerebral and cardiac protection Signup and view all the answers

What contributes to the increased risk of stroke or death after CEA?

Preoperative systolic blood pressure > 160 mm Hg Signup and view all the answers

What is the purpose of transcranial Doppler monitoring during carotid endarterectomy (CEA)?

Detecting emboli in the bloodstream Signup and view all the answers

What is a complication associated with carotid artery angioplasty and stent placement (CAS)?

Reperfusion hypotension Signup and view all the answers

What was traditionally used to determine the need for shunt placement during carotid cross-clamping before the introduction of more sophisticated cerebral monitoring techniques?

Stump pressure measurement Signup and view all the answers

Why is intraoperative EEG and SSEP monitoring used for patients undergoing carotid endarterectomy (CEA)?

To determine the adequacy of cerebral blood flow during cross-clamping Signup and view all the answers

What is the rationale for administering heparin intraoperatively before carotid artery cross-clamping?

To lower the incidence of neurologic deficits in patients Signup and view all the answers

Why is controlling the patient's blood pressure during carotid endarterectomy (CEA) important?

To manage cardiovascular instability during the perioperative period Signup and view all the answers

What is the purpose of carotid shunting during carotid cross-clamping?

To bypass the surgical field and enter the circle of Willis Signup and view all the answers

What is the purpose of reverse anticoagulation with protamine after carotid endarterectomy?

To reduce the incidence of thromboembolic complications Signup and view all the answers

What is the recommended minimum MAP (mean arterial pressure) to be maintained throughout the cross-clamp time during carotid endarterectomy (CEA)?

Maintain the patient's MAP ≥20% of the preoperative MAP Signup and view all the answers

Which medication can be utilized for titratable control of blood pressure if hypertension is sustained during carotid endarterectomy (CEA)?

Labetalol Signup and view all the answers

What is the initial treatment for bradycardia that is caused by the baroreceptor reflex and results in severe hypotension during carotid endarterectomy (CEA)?

Notify the surgeon to release pressure on the carotid sinus Signup and view all the answers

What is one of the postoperative risk factors for the development of cerebral hyperperfusion syndrome after CEA?

Previous carotid artery disease Signup and view all the answers

What is an intervention for sustained systolic blood pressures > 180 mm Hg in the postoperative period after carotid endarterectomy (CEA)?

Administer nitroglycerin Signup and view all the answers

What is the initial intervention after a hematoma is discovered post CEA?

Immediate evacuation of the hematoma Signup and view all the answers

What do significant incisional hematomas post CEA have the potential to cause?

Airway obstruction Signup and view all the answers

What condition is associated with miosis, ptosis, and anhidrosis, resulting from damage to the glossopharyngeal nerve?

Horner syndrome Signup and view all the answers

Which nerve controls the intrinsic muscles of the larynx and can cause hoarseness if unilaterally damaged during CEA?

Recurrent laryngeal nerve Signup and view all the answers

What is the main function of the spinal accessory nerve that may be compromised during CEA?

Control of the sternocleidomastoid and trapezius muscles Signup and view all the answers

What does damage to the hypoglossal nerve result in?

Ipsilateral drift of the tongue Signup and view all the answers

What does unilateral damage to the internal branch of the superior laryngeal nerve result in?

Hoarseness Signup and view all the answers

What is indicative of a possible intraoperative cerebral vascular accident (CVA) when assessing postoperative patients having a CEA?

Ipsilateral smile asymmetry Signup and view all the answers

What is associated with vocal cord paralysis, hoarseness, and respiratory difficulty on the operative side after unilateral damage?

Facial asymmetry Signup and view all the answers

What is an expected consequence of damage to the facial nerve?