Related Experiment Videos
Carotid endarterectomy remains the gold standard
Philip S Mullenix1, Charles A Andersen, Stephen B Olsen
1Department of General Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.
Insights
Carotid endarterectomy (CEA) is a safe and effective standard of care, with outcomes at Madigan Army Medical Center (MAMC) favorably comparing to major trials. CEA results at MAMC surpass those of carotid angioplasty and stenting (CAS).
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid endarterectomy (CEA) is a key procedure for managing carotid artery atherosclerosis.
- Established trials like ACAS and NASCET provide benchmarks for CEA safety and efficacy.
- Carotid angioplasty and stenting (CAS) has emerged as an alternative treatment option.
Purpose of the Study:
- To evaluate the safety and efficacy of CEA performed at a community medical center (MAMC).
- To compare MAMC's CEA outcomes against established standards (ACAS, NASCET) and published CAS data.
- To determine the current role of CEA versus CAS in clinical practice.
Main Methods:
- A retrospective review of 267 CEA procedures on 236 patients at MAMC between 1994 and 2000.
- Prospective collection of patient demographics, indications, and surgical outcomes.
- Comparison of MAMC's CEA data with ACAS, NASCET, and published CAS results.
Main Results:
- The overall perioperative stroke rate for CEA at MAMC was 2.2% (2.2% for asymptomatic, 3.9% for symptomatic patients).
- No perioperative deaths occurred in the MAMC CEA series.
- MAMC's CEA stroke-death rates were comparable to ACAS and NASCET, and superior to reported CAS rates.
Conclusions:
- Carotid endarterectomy (CEA) remains the gold standard for carotid artery disease treatment.
- CEA is a safe, effective, and durable procedure with favorable outcomes achievable at community hospitals like MAMC.
- Current evidence suggests CEA outcomes are superior to CAS, supporting its continued use while CAS trials are pending.
Background:
To compare the safety and efficacy of carotid endarterectomy (CEA) as performed in a community medical center with the Asymptomatic Carotid Atherosclerosis Study (ACAS) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) standards and with representative published results regarding carotid angioplasty and stenting (CAS).
Methods:
Between 1 January 1994 and 31 July 2000, 267 CEA procedures were performed on 236 patients at Madigan Army Medical Center (MAMC). Prospectively acquired patient demographics, operative indications, and surgical outcomes were reviewed using clinical records, carotid duplex evaluations, and follow-up examinations. The resultant data were compared with ACAS, NASCET, and published results of CAS.
Results:
The perioperative stroke rate was 2.2% (6 of 267) overall, 0.7% (1 of 139) among asymptomatic patients, and 3.9% (5 of 128) among symptomatic patients. There were no perioperative deaths from any cause in the entire series. The respective ACAS and NASCET early stroke-death rates were 2.3% (19 of 825) and 5.8% (19 of 328). The largest published series of CAS reported stroke-death rates of 5.7% (299 of 5,210) overall, and 3.4% (46 of 1,361) and 5.8% (93 of 1,614) for asymptomatic and symptomatic patients, respectively.
Conclusions:
CEA remains the standard of care. It is a safe, effective, and durable procedure that can be performed in a facility such as MAMC with outcomes that compare favorably with ACAS and NASCET. Results of CEA at MAMC are superior to similar data regarding CAS. Widespread use of CAS should be deferred pending completion of on-going prospective trials versus CEA.