Developing a neurosurgical carotid endarterectomy practice

During the 1984-85 academic year, our neurosurgical service performed 60 carotid endarterectomy (CEA) procedures. By 1989 the annual number of CEAs performed by the neurosurgical service had fallen to six procedures, primarily because of the loss of patient referrals to an aggressive and well-trained vascular surgery group. At that time, an effort was begun to establish a neurosurgical cerebrovascular service and to compete more effectively for patients with extracranial cerebrovascular disease. Protocols for assuring rapid neurosurgical evaluation, improving communications with referring physicians, and developing innovative surgical and perioperative management protocols for CEA patients were instituted. By use of these strategies the annual number of CEAs performed on our neurosurgical service has increased substantially; from six CEAs done in academic year 1988-89 to 107 CEAs done in academic year 1994-95. The number of CEAs will surpass 120 for the present academic year. This presentation reviews the causes of the precipitous decline in the number of CEAs done by our neurosurgical service from 1985-89 and outlines strategies I have found effective for reestablishing neurosurgeons in the care of patients with surgically treatable extracranial cerebrovascular disease.