[Internal carotid artery endarterectomy--prospective evaluation]

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%).
• 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.