[Morbidity and mortality of carotid endarterectomy]
Virginia A Pujol Lereis1, Sebastian Ameriso, Guillermo P Povedano
1Departamento de Neurología, Instituto de Investigaciones Neurológicas Dr. Raúl Carrea, FLENI, Buenos Aires.
Insights
Carotid endarterectomy (CE) is effective for preventing stroke in patients with carotid stenosis. This study found CE achieved low morbidity and mortality rates, meeting international guidelines in routine practice.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Carotid endarterectomy (CE) is recommended for symptomatic and asymptomatic patients with moderate to severe carotid stenosis.
- International guidelines set strict morbidity and mortality targets (<6% for symptomatic, <3% for asymptomatic patients).
- Evaluating institutional CE outcomes is crucial for adherence to quality standards.
Purpose of the Study:
- To assess the morbidity and mortality rates of carotid endarterectomy (CE) at our institution.
- To determine if outcomes align with international recommendations for CE procedures.
- To evaluate the safety and efficacy of CE in a routine clinical setting.
Main Methods:
- Retrospective analysis of 306 carotid endarterectomy (CE) procedures.
- Outcomes defined as stroke, myocardial infarction, or death within 30 days post-surgery.
- Pre- and post-operative neurological and cardiological assessments; routine intraoperative transcranial Doppler monitoring.
Main Results:
- No deaths were recorded in the 306 procedures performed.
- Overall perioperative morbidity was 2.6% for both symptomatic and asymptomatic patients.
- These results compare favorably with international benchmarks for CE.
Conclusions:
- Carotid endarterectomy (CE) can be safely performed in routine clinical practice.
- Our institution's CE morbidity and mortality rates meet international guidelines.
- CE is an effective and safe procedure for managing carotid stenosis when performed in experienced centers.
Abstract:
Clinical trials in academic centers with high selected surgeons have demonstrated the effectiveness of carotid endarterectomy (CE) in addition to best medical treatment in symptomatic and asymptomatic patients with moderate to severe stenosis. International guidelines recommend that the procedure should be done in centers with morbidity and mortality rates of less than 6% for symptomatic and 3% for asymptomatic patients. We evaluated the morbidity and mortality of CE in our institution. This was defined by the presence of stroke, myocardial infarction and/or death within 30 days of surgery. Surgery was indicated in symptomatic patients with stenosis greater than 50%. For asymptomatic or symptomatic patients with stenosis = 50% treatment was decided on a case-by-case basis. All patients were examined by a neurologist with and a cardiologist before and after the procedure. Intraoperative monitoring with transcranial Doppler was routinely used in patients with adequate ultrasonic window. We evaluated 306 procedures. No deaths occurred. Perioperative morbidity was 2.6% for both, symptomatic and asymptomatic subjects. These numbers compared favorably with those reported by other centers in Latin America and Europe. In conclusion, CE can be performed in routine clinical practice with morbidity and mortality results within those recommended by international guidelines.
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