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[Internal carotid artery endarterectomy--prospective evaluation]

S Toutounchi1, A K Małek, J Leszczyński

  • 1Kliniki Chirurgii Ogólnej i Chorób Klatki Piersiowej Akademii Medycznej w Warszawie.

Wiadomosci Lekarskie (Warsaw, Poland : 1960)
|January 1, 1997
PubMed
Summary

Carotid endarterectomy (CEA) is a safe stroke prevention method for high-grade carotid artery stenosis. This study shows low mortality and no stroke deaths from the operated artery in long-term follow-up.

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Area of Science:

  • Vascular Surgery
  • Neurology
  • Cardiology

Background:

  • Carotid endarterectomy (CEA) is a crucial procedure for preventing stroke in patients with symptomatic high-grade internal carotid artery stenosis.
  • Evaluating the long-term efficacy and safety of CEA is essential for clinical decision-making.

Purpose of the Study:

  • To present the early and late outcomes of carotid endarterectomy (CEA).
  • To assess the effectiveness of CEA in stroke prevention.
  • To evaluate the safety and results of CEA using standard techniques and anesthesia variations.

Main Methods:

  • Prospective evaluation of 270 CEA procedures performed between 1990 and 1996.
  • Preoperative assessment using duplex examination to identify high-grade stenosis (>70%).

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  • Standard CEA technique without patching, with a transition from general to regional anesthesia.
  • Clinical and duplex-scan follow-up ranging from 3 to 72 months post-operation.

    • Main Results:

    • A 1.5% mortality rate (4 deaths) within 30 days, primarily due to myocardial infarction (MI).
    • Long-term follow-up (72 months) showed 12 deaths, mainly from cardiac events or cancer.
    • 11 cases of late recurrent stenosis (>70%) were observed.
    • No deaths attributed to stroke originating from the operated carotid artery.

    Conclusions:

    • Carotid endarterectomy (CEA) is an effective method for stroke prevention in patients with symptomatic high-grade carotid stenosis.
    • Duplex-scan is a reliable tool for both preoperative and postoperative evaluation of carotid arteries.
    • Regional anesthesia facilitates intraoperative neurological assessment, enhancing surgical safety.