Carotid endarterectomy. Controversies and recommendations

Area of Science:

• Vascular Surgery
• Neurology
• Preventive Medicine

Background:

• Carotid endarterectomy is a key intervention for stroke prevention in patients with carotid stenosis.
• Indications are generally clear for hemispheric transient ischemic attacks (TIAs), but less so for non-hemispheric or asymptomatic cases.
• Emergency endarterectomy for acute TIAs carries significant risks.

Purpose of the Study:

• To evaluate the efficacy and safety of carotid endarterectomy for stroke prevention.
• To assess the impact of meticulous surgical technique and intraoperative monitoring on outcomes.
• To define criteria for the appropriate use of prophylactic carotid endarterectomy.

Main Methods:

• Review of 120 carotid endarterectomy cases performed at Straub Clinic.
• Emphasis on meticulous operative technique, including intraoperative angiography and defect repair.
• Analysis of patient selection criteria, focusing on hemispheric vs. non-hemispheric symptoms and asymptomatic patients.

Main Results:

• Elective carotid endarterectomy, when performed with meticulous technique and intraoperative angiography, confirms its benefits.
• The study supports the procedure in carefully selected patients, particularly those with symptomatic carotid stenosis.
• Outcomes were favorable when combined major morbidity and mortality rates were maintained at or below 3%.

Conclusions:

• Carotid endarterectomy is a safe and beneficial stroke prevention strategy in carefully selected patients with carotid stenosis.
• Meticulous surgical technique and comprehensive intraoperative assessment are paramount for achieving low complication rates.
• Prophylactic endarterectomy should only be considered when a very low incidence (≤3%) of major morbidity and mortality is achievable.