Postoperative treatment of patients undergoing carotid endarterectomy.

Carotid endarterectomy is a common procedure aimed at the prevention of cerebral vascular accident. Death after carotid endarterectomy is rare (approximately 1%). Postoperative complications occur infrequently (3% to 5%). Myocardial infarction and cerebral vascular accident, two of the most serious postoperative complications, are often associated with changes in blood pressure that occur early in the postoperative period. In addition, cerebral vascular accident often results from thrombosis at the operative site, which may occur during the operation or in the early perioperative phase. Therefore intense monitoring of neurologic and hemodynamic status during the early postoperative period is advocated to control blood pressure and detect changes in neurologic condition. Traditionally, this care is provided in an intensive care unit. Current studies suggest that more than 80% of patients who undergo carotid endarterectomy do not use unique intensive care unit resources; rather, they require monitoring services, which can be safely provided in less intensive alternate settings. This article provides an overview of carotid endarterectomy. Postoperative complications and early (24-hour) perioperative management are reviewed. Alternative strategies to intensive care unit monitoring are proposed.