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[Advances in surgery for carotid stenosis. 900 operations (1983-1994)]
F Becker1, F Gabrielle, E Tatou
1Service de Chirurgie cardio-vasculaire et d'Angiologie, Hôpital du Bocage, CHU, Dijon.
Insights
Carotid endarterectomy outcomes improved significantly over time. Enhanced pre- and post-operative care, including noninvasive diagnosis and locoregional anesthesia, reduced patient morbidity and mortality.
Area of Science:
- Vascular Surgery
- Cerebrovascular Disease Management
Context:
- Carotid endarterectomy is a critical procedure for preventing stroke in patients with significant carotid artery stenosis.
- Historically, morbidity and mortality rates have been a concern, necessitating continuous improvement in surgical techniques and patient care.
Purpose:
- To evaluate the trends in morbidity and mortality associated with carotid endarterectomy over a 12-year period in a single-center series.
- To identify factors contributing to improvements in surgical outcomes.
Summary:
- A series of 900 carotid endarterectomies were performed for >70% carotid narrowing between 1983 and 1994.
- Mortality rates decreased from 4.56% (1983-1986) to 0.67% (1990-1994).
- Improvements were attributed to enhanced pre-, peri-, and post-operative care, including noninvasive diagnosis (ultrasound duplex), selective use of preoperative angiography, advanced neuroimaging (CT/MRI), locoregional anesthesia, and postoperative blood pressure monitoring.
Impact:
- Demonstrates a significant reduction in carotid endarterectomy morbidity and mortality through comprehensive care improvements.
- Highlights the value of noninvasive diagnostic tools and modern anesthetic techniques in vascular surgery.
- Provides a benchmark for optimizing patient outcomes in cerebrovascular surgery.
Objectives:
To evaluate morbidity and mortality in carotid endarterectomy in a personal series.
Methods:
Nine hundred endartectomies were performed from 1983 to 1994. All patients had > 70% carotid narrowing. Five hundred five patients underwent without preoperative angiography.
Results:
Outcome was analyzed for 3 periods showing decreasing mortality from 4.56% in 1983-86 to 0.67% in 1990-1994.
Conclusion:
The reduction in morbidity and mortality resulted from the combined effects of pre-, per-, and post-operative care including noninvasive preoperative diagnosis of internal carotid artery stenosis using ultrasound duplex and surgery without previous angiography, delayed surgery in case of recent prolonged hemispheric deficit or of ischemic defect detected on computed tomography (CT) or magnetic resonance imaging (MRI), cerebral evaluation with CT-scan or MRI the day before operation, surgery under locoregional anesthesia, monitoring of arm arterial blood pressure during the first 24 hours following surgery.