Carotid endarterectomy: experience in 5425 cases

Carotid endarterectomy (CE) is a surgical treatment for carotid artery stenosis. Prior research has shown its effectiveness in reducing stroke risk in patients with significant stenosis. However, the long-term outcomes and complication rates in large patient cohorts remain unclear. No prior work had resolved the balance between cost reduction and surgical quality in high-volume centers. This gap motivated the need for a detailed analysis of CE outcomes in a large case series. The study aimed to address the lack of comprehensive data on CE safety and efficacy in a real-world clinical setting. It also sought to clarify the role of specific surgical techniques and monitoring protocols in reducing complications. The researchers focused on identifying how clinical protocols could be optimized without compromising patient outcomes. Their work contributes to the ongoing discussion on stroke prevention and surgical quality in vascular care.

This study aimed to evaluate the outcomes of carotid endarterectomy in a large cohort of patients. The researchers wanted to assess the effectiveness of CE in preventing stroke in both symptomatic and asymptomatic cases. They also sought to determine the impact of various surgical techniques on complication rates. The motivation was to identify best practices that could be implemented in other centers. The study focused on a 10-year period to capture long-term trends in surgical care. The researchers aimed to analyze the role of preoperative imaging, anesthesia, and monitoring in reducing risks. They also wanted to evaluate the influence of ICU use and early discharge on patient outcomes. Their goal was to provide evidence that CE can be both safe and cost-effective in experienced centers.

The study included 3967 patients who underwent 5425 CE procedures from 1992 to 2002. Patient data were collected from a single institute to ensure consistency. The researchers used a clinical protocol designed to reduce complications and optimize resources. Preoperative evaluation included validated duplex scanning in 86.9% of cases. Locoregional anesthesia and neurological monitoring were used during cross-clamping in 96.3% of procedures. Selective shunting with a Javid shunt was performed in 10.7% of cases. Surgical techniques varied based on carotid anatomy and cerebral tolerance. Intraoperative arteriography was used selectively for eversion endarterectomy. Postoperative ICU admission was limited to 2% of cases. Early discharge was considered for uncomplicated patients. The researchers analyzed mortality and morbidity rates to evaluate the effectiveness of their protocol.

The overall perioperative mortality rate was 0.37% (20/5425). Causes of death included myocardial infarction in 7 cases, ischemic stroke in 6, and hemorrhagic stroke in 5. Perioperative neurological morbidity was 1.31% (71/5425), with 43 major and 28 minor strokes. The most common surgical techniques were synthetic patching (46.4%) and eversion endarterectomy (41.5%). Intraoperative arteriography was used routinely for eversion endarterectomy. Locoregional anesthesia and monitoring were used in 96.3% of cases. Duplex scanning was the primary preoperative exam in 86.9% of patients. ICU admission was selective, with only 2% of patients requiring it. Early discharge was considered safe in uncomplicated cases. The researchers concluded that low mortality and morbidity rates were achieved in this high-volume center.

The study authors concluded that carotid endarterectomy is effective for stroke prevention in patients with significant carotid stenosis. They found that low mortality and morbidity rates can be achieved in an experienced center. The researchers emphasized the importance of a well-designed clinical protocol in reducing complications. They noted that cost reduction did not negatively affect the quality of surgical care. The use of validated preoperative imaging and selective shunting contributed to better outcomes. The authors suggested that locoregional anesthesia and monitoring are key to minimizing risks. They also highlighted the role of early discharge in reducing hospital costs. Their findings support the continued use of CE in appropriate patient populations.