Review of 272 consecutive carotid endarterectomies in a smaller community

The safety of carotid endarterectomy in the community hospital has been questioned when compared with the morbidity and mortality in the university hospital setting. The results of 272 carotid endarterectomies consecutively performed during a 41 month period by one fellowship-trained vascular surgeon at two small community hospitals are reported in this retrospective study. Of the procedures, 234 (86 per cent) were performed for symptomatic lesions and 38 (14 per cent) for asymptomatic high-grade (greater than 50 per cent) stenoses. There were eight postoperative strokes and one early death for a combined morbidity and mortality rate of 3.3 per cent. Transient neurologic deficits included five patients with a transient ischemic attack lasting less than 24 hours and one patient with a reversible ischemic neurologic deficit lasting less than 72 hours. No postoperative strokes or deaths occurred in the 38 procedures done upon asymptomatic patients. These results suggest that an appropriately trained vascular surgeon can safely perform carotid endarterectomy in the community hospital setting when the operation is performed with optimum support from the anesthesiologist and perioperative monitoring. Both electroencephalographic monitoring and cerebral stump pressures were used. There was no statistically significant difference in stroke rates in those patients who were monitored and who underwent a shunt procedure on the basis of the electroencephalogram versus those who underwent shunting procedures on the basis of carotid stump pressures, although a trend was suggested.