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Left-side preference in carotid endarterectomies.
B G Maxwell1, J G Maxwell, C C Brinker
1Department of Surgery, Coastal Area Health Education Center, Wilmington 28402-9025, USA.
The American Surgeon
|August 31, 2000
Summary
Left carotid endarterectomies (CEs) are performed more often than right CEs, though outcomes are similar. Surgeons may consider patient dominance when deciding which side to operate on.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease
- Surgical Outcomes
Background:
- Carotid atheromatous disease incidence is presumed equal between right and left carotid arteries.
- Previous studies have not reported differences in the frequency of right versus left carotid endarterectomies (CEs).
Purpose of the Study:
- To investigate if right and left CEs are performed with equal frequency.
- To determine if there are outcome differences between left and right CEs.
- To explore surgeon practices regarding side selection for CE.
Main Methods:
- Retrospective chart review of 2305 CEs performed between 1979 and 1998.
- Data collection included side of procedure, demographics, comorbidities, procedural details, hospital stay, and complications.
- Surgeon survey on practice patterns and consideration of side-related factors.
Main Results:
- Left CEs (52%) were performed significantly more often than right CEs (48%) (P = 0.014).
- No significant differences were observed in demographics, comorbidities, preoperative symptoms, length of stay, or postoperative morbidity/mortality between left and right CEs.
- A majority of surveyed surgeons consider the relationship between the side of carotid disease and the patient's dominant side.
Conclusions:
- A statistically significant disparity exists in the frequency of left versus right carotid endarterectomies.
- This difference may be influenced by surgeons' consideration of the side supplying the dominant hemisphere.
- Further prospective studies are needed to explore the impact of CE side and patient dominance on outcomes.