Durability of carotid endarterectomy☆

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Conclusion: In a consecutive series of 1000 carotid endarterectomies (CEAs), the authors had a 30-day all stroke and death rate of 1.9% and a recurrent stenosis rate (G70% stenosis) in the operated artery of 0.1%, with a mean time to recurrence of 4 + 2 years.

Summary: This is a report of 1000 consecutive CEAs from the Department of Neurosurgery at the Mayo Clinic. There were 680 men, 320 women, aged 69 + 8 years. Follow-up averaged 7.1 years (range, 2 to 11 years). Symptomatic internal carotid artery stenosis was present in 59% of the patients. All CEAs were performed with preoperative aspirin, intraoperative heparin, intraoperative EEG monitoring, and selective shunting based on EEG changes. Routine patch closure was used.

The combined 30-day all stroke and death rate was 1.9%. There were 9 deaths (0.9%); 6 were neurologic and 3 were cardiac. There were 10 strokes (1.0%). Of the 10 strokes, 7 made good recovery. Recurrent internal carotid artery stenosis of G70% as documented by duplex scanning was found in only 10 patients (0.1%). The mean time to recurrence was 4 + 2 years and only 2 of the recurrences were symptomatic.

Comment: This is another of a number of large, single institutional series of carotid endarterectomies documenting excellent short-term morbidity and mortality and long-term durability of CEA. This, and similar studies, have likely been stimulated by the increasing “visibility” of carotid stenting. The results of this study, however, while excellent, will have absolutely no impact on the debate of CEA versus carotid stenting. A properly performed randomized trial is required.