Carotid endarterectomy--indications, techniques, and Mayo Clinic experience

Carotid endarterectomy is an effective surgical option for the prevention of stroke. However, the indications and risks associated with this procedure vary between individual surgeons and institutions. The aim of this review is to analyze the current indications for intervention and recent operative experience at a single institution, the Mayo Clinic. Recent trials are assessed and integrated with our management policy. Important aspects of anesthesia, monitoring, and operative technique are described along with rationale for their use. Outcome of patients operated on in the last 25 years is assessed with respect to grade. In the period from 1972 to 1995 there have been 3831 cases. Overall major morbidity and mortality is 1.8% for 3665 patients with primary stenosis. For 113 patients with recurrent stenosis it is 8.5%. Comparison with a previous interim review in 1986 demonstrates a modest improvement in the more recent cases. It is proposed that improvements in anesthesia and perioperative care are principally responsible for this improvement. The importance of institutional audit of results is emphasized because surgical morbidity is a major factor in decision-making.