Postoperative somnolence in patients after carotid endarterectomy.

Eighty-on. patients undergoing carotid endarterectomy were divided into two groups based on the degree of stenosis of the carotid artery. GT.tlP 1, 37 patients, was defined as having severe carotid stenosis (>70%). Grol./p lI, 44 patients, was defined as having mild «40%) or moderate (40% to 70%) carotid artery stenosis. Both groups were e""luated for neurologic and psychologic changes in the postoperative period. Prospe<:tive analysis demonstrated no significant differences between grOtlPS I and II in the areas of cardiac disease, history of preoperative stroke, preoperative and postoperative hypertension, diabetes, or postoperative computed tomography changes. Group II had a significantly higher percentage oj carotid artery ulceration (p < 0.07). Postoperative analysis revealed 34 group [ patients had (; to 8 weeks of lethargy versus two group II patients (p < 0.01). Eleven group I patients had headaches for the first week postoperatively versuS three patients in group 11 (p < 0.05). Fou.r group I patients had paranoid ideation, and another jour patients had clinical depression, but not one patient in group I1 (p < 0.01) had these psychiatric disturbances. These data suggest that significant, reversible neurologic and psychologic changes can occur becau.se of r.perfusion after r.lief of severe stenosis oj the carotid artery. (SURGERY 7990,.107:6847.)