Indications and complications of carotid endarterectomy as performed by four different surgical specialty groups

The results of 518 carotid endarterectomies (CEA) performed by four surgical specialty groups were evaluated for complications and categorized according to their presentations. Nineteen surgeons performing CEA were classified into four groups: general surgeons (GS), general vascular surgeons (GVS), cardiovascular surgeons (CVS), and neurosurgeons (NS). The stroke and combined stroke and death rates respectively by the four groups were 6.1% and 6.1%; 3.2% and 3.5%; 6.5% and 8.7%; and 6.5% and 6.5%. The indications of CEA varied among the groups. Asymptomatic stenosis constituted 10.6%, 16.0%, 19.0%, and 0% of the total CEA performed by the groups respectively; nonhemispheric transient ischemic attacks (TIA) constituted 3.0%, 18.4%, 8.7%, and 0%; hemispheric TIA constituted 77.3%, 58.1%, 63.0% and 90.3%; and stroke constituted 9.1%, 7.5%, 8.7% and 9.7%. When CEA for asymptomatic stenosis and nonhemispheric TIA were combined, the stroke rate was 22.2% for the GS group; 1.6% for the GVS group; and 15.4% for the CVS group. In conclusion, the overall stroke rate was close for the four groups at 6.1%, 3.2%, 6.5% and 6.5% respectively. However, asymptomatic and nonhemispheric TIA patients had significantly lower complication rates when operated on by the GVS group in contrast to the other groups (1.6% for the GVS in contrast to 22.2% for the GS and 15.4% for the CVS). The GVS and CVS groups operated more frequently on asymptomatic and nonhemispheric TIA patients than the GS and NS groups.