Carotid endarterectomy in a metropolitan community: The early results after 8535 operations

• Published in: Journal of vascular surgery Vol. 7; no. 2; pp. 256 - 260
• Main Authors: Rubin, Jeffrey R., Pitluk, Howard C., King, Terry A., Hutton, Max, Kieger, Edward F., Plecha, Fred R., Hertzer, Norman R.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Mosby, Inc 01.02.1988; Elsevier
• Subjects: Aged; Biological and medical sciences; Carotid Arteries - surgery; Carotid Artery Diseases - surgery; Endarterectomy; Evaluation Studies as Topic; Female; Humans; Male; Medical sciences; Neurology; Ohio; Postoperative Complications; Registries; Retrospective Studies; Safety; Vascular diseases and vascular malformations of the nervous system; Ohio; Human; Nervous system diseases; United States; Stenosis; North America; Epidemiology; Treatment; Follow up study; Carotid; Surgery; America; Metropolitan area; Endarteriectomy; Cerebrovascular disease
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/0741-5214(88)90144-9

Several retrospective community surveys have provoked speculation concerning the safety of carotid endarterectomy (CEA) throughout the United States. To address this serious issue, surgical outcome was calculated for 8535 CEAs entered prospectively into a computer registry by 51 trained vascular surgeons in a large metropolitan area from 1973 to 1985. A total of 7480 procedures (88%) were performed for symptomatic lesions and 1055 (12%) were performed for asymptomatic stenosis or ulceration. There were 178 operative strokes (2.1%) and 135 early deaths (1.6%), for a combined morbidity-mortality rate of 3.2%. Fatal events were attributed to cardiac disease in 0.7%, neurologic complications in 0.6%, and other causes in 0.3%. The stroke rate (n = 148; 2.0%) in symptomatic patients was better than that in asymptomatic patients (n = 30; 2.8%) (χ2 = 5.2; p < 0.025), but the combined morbidity-mortality rates (2.9% and 3.7%) were not statistically different. The incidence of stroke reported by surgeons who performed more than 5 CEAs annually (1.7%) was statistically superior to the stroke rate (3.4%) among those with less experience (χ2 = 37.1; p < 0.0001). Nevertheless, both groups had acceptable results that were consistent with their training and continued interest in vascular surgery.