{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T23:29:11Z","timestamp":1776468551555,"version":"3.51.2"},"reference-count":84,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1986,7]]},"abstract":"<jats:p content-type=\"fine-print\">\u2713 Carotid endarterectomy has the potential to improve on the natural history of untreated carotid artery disease with respect to subsequent infarction in symptomatic patients with causative angiographic lesions. This benefit of a reduced risk of stroke can be realized only if the perioperative morbidity and mortality rates are kept low. An approach to symptomatic carotid artery bifurcation disease is outlined, with a defined protocol of microsurgical endarterectomy utilizing barbiturate protection during the period of potential focal temporary cerebral ischemia. This protocol includes preoperative antiplatelet therapy, barbiturate anesthesia, the avoidance of an internal shunt, the use of the operating microscope, and strict control of postoperative hypertension. A series of 200 consecutive endarterectomies performed within this protocol in 180 patients and the resultant combined permanent morbidity and mortality rate of 1.5% are reported.<\/jats:p>","DOI":"10.3171\/jns.1986.65.1.0063","type":"journal-article","created":{"date-parts":[[2009,5,8]],"date-time":"2009-05-08T16:13:28Z","timestamp":1241799208000},"page":"63-73","source":"Crossref","is-referenced-by-count":72,"title":["Microsurgical endarterectomy under barbiturate protection: a prospective study"],"prefix":"10.3171","volume":"65","author":[{"given":"Robert F.","family":"Spetzler","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark N.","family":"Hadley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard A.","family":"Thompson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Wilkinson","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter A.","family":"Raudzens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Lancet","first-page":"871","article-title":"Observations on the natural history of transient cerebral ischaemia.","volume":"2","author":"Acheson","year":"1964"},{"key":"b2","series-title":"Medicine","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1097\/00005792-198107000-00005","article-title":"Carotid endarterectomy: a prospective study of its efficacy and safety.","volume":"60","author":"Allen","year":"1981"},{"key":"b3","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"723","DOI":"10.1161\/01.STR.12.6.723","article-title":"Thresholds in cerebral ischemia \u2014 the ischemic penumbra.","volume":"12","author":"Astrup","year":"1981"},{"key":"b4","series-title":"Surgery","first-page":"112","article-title":"Durability of carotid endarterectomy.","volume":"94","author":"Baker","year":"1983"},{"key":"b5","series-title":"Ann NY Acad Sci","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/j.1749-6632.1972.tb16285.x","article-title":"Adhesion of platelets to subendothelium.","volume":"201","author":"Baumgartner","year":"1972"},{"key":"b6","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1227\/00006123-198407000-00010","article-title":"Cerebral hyper-perfusion after carotid endarterectomy: a cause of cerebral hemorrhage.","volume":"15","author":"Bernstein","year":"1984"},{"key":"b7","series-title":"Am J Surg","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1016\/0002-9610(67)90378-9","article-title":"Technical result of carotid endarterectomy. 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