Reducing the risk of intraoperative neurological complications during carotid endarterectomy with early distal control of the internal carotid artery

AIM OF THE STUDY: To assess the feasibility and effectiveness of a modified surgical technique with early clamping of the distal internal carotid artery (ICA) during carotid endarterectomy in a single centre experience. STUDY DESIGN: Retrospective study, teaching hospital. MATERIAL AND METHODS: Between 1996 and 2002, 2235 CEAs were performed. Until April 1999, the intra-operative strategy consisted of standard isolation and dissection of the carotid bifurcation preliminary to ICA clamping (group 1; 1090 interventions). Starting from May 1999, we performed early isolation and clamping of the distal ICA, followed by dissection of the carotid bifurcation and clamping of the external and common carotid artery (group 2; 1145 interventions). RESULTS: The modified technique was feasible in all the patients of group 2. In group 2 there was a significantly lower incidence of neurological deficit on waking than in group 1 (0.4% and 1.8%, respectively; p=0.02). CONCLUSIONS: Early distal control of the internal carotid artery during CEA is feasible and could contribute to reducing intra-operative neurological events.