Predictors of neck bleeding after carotid endarterectomy: A 5 year revision

Abstract

Introduction

The aim of this study was to determine the incidence of neck bleeding, requiring or not surgical intervention, after carotid endarterectomy (CE) and to identify its predictive parameters and its influence in stroke, myocardial infarction (MI) and mortality.

Methods

This was a retrospective review of 200 CEs carried out in 194 patients between 2010 and 2014 in our institution. The endpoints were: postoperative major cervical bleeding MB (that required reintervention) and global cervical bleeding GB (registered neck bleeding) as also its major post reintervention complications. Patient demographics, antiplatelet and anticoagulant therapy (pre, intra and postoperative), anesthetic data, surgical technique, and perioperative management data were collected. Univariate analysis with Pearson chi-Squared or Fisher Test was applied for categorical variables and t-test for continuous variables.

Results

Neck bleeding after CE occurred in 25 cases (12%), requiring reoperation in 8 cases (4.0%). Univariate analysis (Pearson chi-squared test) showed significance (p < 0.05) for global hematoma in which concerns clopidogrel use until surgery (p = 0.04), elevated mean arterial pressure during hospitalar stay (p = 0.006). For major hematoma it has significance previous dual antiplatelet therapy (p = 0.039), patch use compared to other techniques (p = 0.017), and neurological repercurssion after clamping (p = 0.03). Individual analysis of surgical technique did not show significant value for major or global hematoma. There were to 2 deaths, one related to reeintervention, 2 strokes and one MI nonprocedure associated.

Conclusions

Carotid hematoma is a devastating and relatively common complication in our institution although the incidence of major hematoma is reduced. The main factors associated with reeintervention were previous double anti-platelet therapy, non-patch surgical techniques and patient neurological instability (shunt use), probably associated with less accurate hemostasis. Global bleeding is related to the use of clopidogrel 24 h before, and as post-operative factors poor tensional control (high)