Carotid endarterectomy: time-trends and results during a 20-year period

The aim of this study was to evaluate the results following surgery for carotid artery stenosis in a single institution during a 20-year period.

In a retrospective study, 556 operations were performed in 496 patients during the period 1983-2002. Comorbidities, mortality, stroke and other surgical and general complications were recorded. Follow-up was performed and data retrieved from medical records, questionnaires, and visits to local hospitals. Data on late mortality were retrieved from the Norwegian Registrar's Office of birth and deaths.

The mean age was 66.9 years (range 43-84 years), and 60% were men; 84% had symptomatic carotid artery stenosis. General anesthesia was applied in 95.5%. A shunt was used in 61.3%, and patch angioplasty in 95.1%. Autologous vein patch was used in almost all cases and there were no cases of patch rupture. Postoperative myocardial infarction occurred in 16 (2.9%) of the patients, and 5 were fatal. All types of stroke within 30 days of surgery occurred in 23 (4.1%) including 1 fatal stroke, and 7 patients died of other causes. The total stroke/mortality rate was 5.4%. Patients with previous coronary artery bypass had a favorable outcome regarding long-time survival. In contrast, increasing age, diabetes, renal failure and intermittent claudication predicted reduced long-term survival. No operations were performed for recurrent stenosis.

We have used fairly the same policy regarding operative technique during the 20-year period and the results are in agreement with those presented in large international trials. The long-term results were favorable, and improved over time, probably due to better preoperative evaluation of the patients, better timing of surgery and treatment of comorbidities.