Factors associated with perioperative complications during carotid endarterectomy.
Records from 166 cases of unilateral carotid endarterectomy were reviewed to investigate the association of certain preoperative and intraoperative factors with perioperative complications including hypertension and hypotension, neurologic deficit, myocardial infarction, and mortality. No myocardial infarctions occurred and mortality was zero. Complications associated with some of the study factors included postoperative hypertension and neurologic deficit. Postoperative hypertension occurred more frequently (a) in patients with poor preoperative blood pressure (BP) control (BP greater than or equal to 170/95 torr) than in those with adequate control (BP less than 170/95 torr) or normotension (52%, 35%, and 17%, respectively, p less than 0.01) and, (b) when additional peripheral vascular disease was present (43% vs 25%, p less than 0.05). The incidence of neurologic deficit was higher when hypertension developed after surgery (20%) than when patients remained normotensive (6%) or developed hypotension (0%, p less than 0.05). Patients whose hypertension was poorly controlled had a greater incidence or transient neurologic, deficit (23.8%) than patients with controlled hypertension (2.5%) or patients with normotension (1.5%, p less than 0.01); permanent neurologic deficit occurred more frequently in those with bilateral disease on angiography than in those with unilateral disease (8.8% vs 1.2%, p less than 0.05).