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[Immediate and long-term results of carotid endarterectomy: the Zurich experience]
T Carrel1, M Pasic, U Niederhäuser
1Departement Chirurgie, Universitätsspital Zürich.
Insights
Carotid endarterectomy effectively treats symptomatic extracranial carotid stenosis, significantly reducing stroke risk. This procedure shows improved survival and decreased mortality rates over time, with cardiac complications being the main cause of late death.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Context:
- Extracardial carotid artery disease is a common cause of transient ischemic attack and cerebral infarction.
- A review of 485 patients undergoing carotid endarterectomy between 1978 and 1991.
- Patients included those with symptomatic carotid disease and asymptomatic individuals with significant stenosis or ulceration.
Purpose:
- To evaluate the efficacy and safety of carotid endarterectomy.
- To analyze early and late cardiac and neurological complications.
- To assess long-term survival and stroke-free survival rates.
Summary:
- Carotid endarterectomy was performed on 485 patients, with 432 symptomatic and 53 asymptomatic.
- Lesions included >75% stenosis, ulceration, bilateral stenosis, and unilateral stenosis with contralateral occlusion.
- Overall early mortality was 1.8%, decreasing over time. Actuarial survival at 8 years was 76.1%, with stroke-free survival at 81.5%.
Impact:
- Carotid endarterectomy is the preferred treatment for symptomatic high-grade extracranial carotid stenosis in suitable patients.
- Mortality rates decreased significantly from 2.4% (1978-1984) to 0.8% (1985-1991).
- Late mortality is primarily attributed to ischemic cardiac complications.
Abstract:
Extracardial carotid artery disease is a frequent cause of transient ischemic attack and of cerebral infarction. The records of 485 patients who underwent carotid endarterectomy between 1978 and 1991 were reviewed, with special attention to both cardiac and neurological complications. 432 patients had symptomatic carotid disease whereas 53 were asymptomatic but presented with significant carotid stenosis or a large ulceration at doppler-duplex examination and/or angiography. These examinations showed the following lesions in symptomatic patients: unilateral stenosis > 75% (331; 68.5%), ulceration (41; 8.5%), bilateral stenosis (61; 12.5%) and unilateral stenosis with contralateral occlusion (51; 10.5%). Intraluminal shunt was used in nearly all patients whereas special management of cerebral metabolism (intraoperative electroencephalogram, somatosensory evoked potentials) were used in high-risk patients only. Overall early mortality was 1.8%. Three patients died from the sequelae of a neurologic injury, whereas six patients died from myocardial infarction or intractable arrhythmia. Mortality decreased from 2.4% between 1978 and 1984 to 0.8% between 1985 and 1991. At 6 and 8 years, actuarial survival rates of 88.1% and 76.1% and stroke-free survival rates of 86% and 81.5% were observed. Late mortality was essentially due to ischemic cardiac complications (38.5% of the actuarial late mortality at 8 years). Review of the literature shows that carotid endarterectomy is the treatment of choice for symptomatic high-grade extracranial carotid stenosis in patients who are not high-risk candidates.(ABSTRACT TRUNCATED AT 250 WORDS)