The outcome of 100 consecutive carotid endarterectomies performed in the HCPA, from january 1993 until june 1997 is analized. The patients were analyzed accordingly to sex, pre-operative risks, shunt and patch use, contralateral stenosis or occlusion and early post-operative complications. A predetermined protocol regarding shunt and patch use was established. The shunt was indicated when the retrograde pression in the lCA was lower than 50% of mean arterial pressure or < 40% without oscillations and the patch was indicated when the internaI carotid artery diameter was < 4 mm. Siexty two patients were males and 35females. Twenty three had bilateral hemodynamic stenosis or occlusion. An internaI shunt was used in 15 patients and patch in others 13. A total of 82 cases had an ischemic encephalic event (AIT or stroke) and 18 were asymptomatic. Twenty one patients had symptomatic pulmonary obstrutive disease, 52 patients had coronary symptoms, 32 had diabetes and 84 where receiving drugs to treat systemic hypertension. Two patients in the symptomatic group had postoperative stroke. To control postoperative hypertension 27 patients where treated with sodium nitroprussiate. Six hematomas and 4 severe headaches as part ofhyperperfusion syndrome where observed. One local nerve injury was detected. There was no obits in this group ofpatients. The lower index ofneurologic complications (2%) and the absence ofdeaths observed with our protocol are in accordance with international standards and justify its routine use.

Os autores relatam sua experiência com as últimas 100 endarterectomias de carótida realizadas no HCPA de janeiro de 1993 a junho de 1997 sob anestesia geral e sem outro procedimento cirúrgico associado. Os pacientes foram avaliados quanto ao sexo, fatores de risco pré-operatórios, uso de remendo (patch) e derivação temporária (shunt), estenose hemodinâmica ou oclusão contralateral e complicações pós-operatórias imediatas. Foi utilizado o protocolo do Serviço de Cirurgia Vascular. O shunt foi indicado quando a mensuração da pressão retrógrada na carótida interna era 70%. Oitenta e dois casos apresentaram evento isquêmico ipsilateral prévio, e 18 eram assintomáticos. Utilizou-se patch em 13 e shunt em 15 pacientes. Vinte e um pacientes tinham DBPOC e 52 cardiopatia isquêmica, 32 eram diabéticos e 84 tinham HAS. No pós-operatório imediato 2 pacientes previamente sintomáticos (um acidente isquêmico transitório e um acidente vascular cerebral) desenvolveram AVC isquêmico ipsilateral. Para o controle da pressão arterial no pós-operatório, 27 pacientes necessitaram de nitroprussiato de sódio. Observou-se hematoma em 6 casos, cefaléia em 4, sem a presença de convulsões, e uma lesão de nervo periférico. Não ocorreu óbito nesta série. O índice de complicações neurológicas observado (2%), sem óbito, está dentro dos padrões internacionais e justificam o protocolo em uso.