Clinical Experiences of Carotid Endarterectomy at Samsung Medical Center

J Korean Neurol Assoc > Volume 14(4); 1996 > Article

Journal of the Korean Neurological Association 1996;14(4): 900-910.

삼성의료원에서 경험한 경동맥 내막 절제술에 대한 임상보고

최낙천, 이광호 이병붕*

삼성의료원 신경과 , 혈관 외과*

Clinical Experiences of Carotid Endarterectomy at Samsung Medical Center

Nack-cheon Choi, M.D., Kwang-ho Lee , Byung-boong Lee, M.D.* Depatment of neurology and Vascular Surgery*, Samsung Medical Center

Department of neurology and Vascular Surgery*, Samsung Medical Center

Abstract

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) demonstrated the superiority of endarterectomy over medical management for symptomatic carotid stenosis of 70-99%. More recently, the Asymptomatic Carotid Atherosclerosis Study (ACAS) showed a statistically significant reduction in stroke incidence after carotid endarterectomy (CEA) in asymptomatic carotid stenosis of 60-99%. But CEA has not been frequently performed in Korea. We reviewed the 38 CEA cases which were performed from November 1994 to September 1996 in respect to clinical presentations, findings of brain and neurovascular imaging, and complications. The risk factors were hypertension in 25 patients, hyperlipidemia in 23, smoking in 20, transient ischemic attack (TIA) in 20, minor stroke in 12, heart disease in 17 (coronary artery disease in 16 and sick sinus syndrome in 1) , and DM in 13. The clinical presentations of 28 symptomatic carotid stenosis included hemispheric TIA in 17 patients, retinal TIA in 2, and minor stroke in 9. Of 10 asymptomatic carotid stenosis included coronary heart disease in 7 patients, asymptomatic carotid bruit in 3, posterior cerebral artery territory infarction in 4, and vascular claudication in 1. The degrees of carotid artery stenosis were measured by use of the linear-based methods of NASCET on the selected carotid angiography. The locations of carotid artery stenosis were near the bifurcation area in 28 cases, proximal ICA in 9, and common carotid artery in 1. Four out of 9 cases with proximal ICA stenosis at above 2 cm distal to bifurcation had long segmental stenosis more than 3 cm in length. Among them 3 cases had separated multi-segmental stenosis of proximal ICA. CEA was performed unilaterally in 28 patients and bilaterally in 5. Thirty0eight CEAs had carotid artery stenosis of 70-99% in 25 cases (4 had ulceration), 50-69% in 7 (2 had ulceration), 30-49% in 3 (all had ulceration), and 0-29% in 3 (all had ulceration). Of 38 CEAs 7 cases had stenosis (>50%) and/or occlusion of intracranial arteries and 15 had stenosis and/or occlusion of contralateral carotid artery. Peri-operative complications included minor ischemic stroke in 1 case, death in 1, and frontal lobe syndrome in 1.