Carotid Endarterectomy: experience in 8743 cases

introduction: Recently published case series of patients undergoing carotid endarterectomy suggested a reduction
in the rate of perioperative neurologic events when compared to those reported in the large randomized
trials performed in the 1990s, without great differences between high and low risk patients.
methods: As a major center of Vascular Surgery we prospectively collected data on 8743 carotid endarterectomy
procedures (eversion technique 75%, patch closure 17.5%) performed in the period 1992-2009.
results: Perioperative mortality was 0.32% (27/8743) with myocardial infarction being the most frequent
cause (9 patients). Perioperative neurological morbidity was 1.04% (91/8743) with 51 major and 40 minor
strokes. In 201 cases (2.3%) a cervical hematoma (suture-line bleeding in 41 cases and or diffuse oozing in 160
cases) in the early postoperative period necessitated urgent wound revision. In 262 (3.0%) cases we observed
permanent or transient lesions of cranial nerves in the postoperative period. There was no significant difference
in the combined ipsilateral stroke and perioperative death rate in octogenarian patients (2.1% in octogenarians
and 1.2% in younger patients, p>0.05), even though an increasing trend was evident.
conclusions: Carotid endarterectomy has a reduced rate of perioperative complications when compared to
those previously reported in literature. The low complication rate is related to improved preoperative patients
evaluation, surgeons’ increasing experience and to surgical and anesthesiological techniques. Carotid angioplasty
and stenting should have their results compared to these real world results of carotid endarterectomy in
order to asses their reliability when treating extracranial cerebrovascular disease.