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Carotid endarterectomy--when to do it, how to do it?
1Neurochirurgische Klinik, Klinikum Grosshadern, Munich, Federal Republic of Germany.
Acta Neurochirurgica
|January 1, 1995
Summary
Carotid endarterectomy improves stroke-free survival for patients with high-grade internal carotid artery stenosis. However, benefits for asymptomatic patients are small and depend heavily on minimizing procedural risks.
Area of Science:
- Vascular Surgery
- Neurology
- Cardiology
Background:
- Major carotid endarterectomy trials have concluded, allowing for defined indications.
- Carotid endarterectomy improves stroke-free survival in symptomatic and asymptomatic patients with high-grade internal carotid artery stenosis when performed by experienced teams.
Purpose of the Study:
- To define indications for carotid endarterectomy.
- To review pre-operative work-up, surgical procedures, and post-operative management.
- To identify accepted safety standards and areas of uncertainty in carotid endarterectomy.
Main Methods:
- Review of major carotid endarterectomy trials.
- Analysis of peri-operative management and surgical techniques.
- Discussion of quality control programs and performance standards.
Main Results:
- Carotid endarterectomy is beneficial for symptomatic and asymptomatic patients with high-grade stenosis.
- Risk reduction in asymptomatic patients may be small, influenced by coincident factors like coronary artery disease.
- Procedural risk and management flaws can negate benefits, especially in asymptomatic patients.
Conclusions:
- Carotid endarterectomy indications are now defined by trial data.
- Benefit hinges on low procedural risk, with strict morbidity/mortality targets (<6% symptomatic, <3% asymptomatic).
- Ongoing controversies exist regarding peri-operative management and routine pre-operative arteriography.