Key result
Carotid endarterectomy performed by a two-surgeon team resulted in a low 30-day morbidity rate of 1.7% and 0.0% mortality, demonstrating safety for treating carotid artery stenosis.
Observational (n=121)
No
A standardized CEA protocol performed by a dedicated two-surgeon team achieved low periprocedural morbidity (1.7%) and zero mortality, meeting established safety criteria for both symptomatic and asymptomatic carotid stenosis.
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Two-surgeon CEA linked to low morbidity; observational data leave open generalizability, requiring RCTs before practice change.
Carotid endarterectomy (CEA) has been established to prevent cerebral infarction due to carotid artery stenosis. However, periprocedural risks under 3% for asymptomatic stenosis and 6% for symptomatic stenosis must be maintained to justify the indications. We evaluated our technique and outcomes of CEA to verify whether our protocol of CEA management can meet the criteria. Between February 2007 and September 2010, 121 consecutive patients with 124 stenosed carotid arteries were treated by the same two surgeons. The patients were among the CEAs at our faculty during the same period. There were 108 men and 13 women with a mean age of 70. Symptomatic and asymptomatic arms included 35 and 89 CEAs, respectively. We performed CEAs under general anesthesia with orotracheal intubation, routinely using the T shaped shunt tube. The mean operative time was 186.5 minutes (±34.3). We found that when carotid bifurcation level was higher, the operative time tended to be longer. Mean length of hospital stay after CEA was 10.3 days (±3.5). Of 124 CEAs, three cases demonstrated neurological deteriorations at the time of discharge; one had dysphagia continuing after discharge, one had new cerebral infarction with deteriorated pre-existing hemiparesis and hyperperfusion just after the procedure and one had new cerebral infarction and dysphagia with difficulty of food intake. Three cases had hyperperfusion greater than a 100% increase in the corrected regional cerebral blood flow compared with preoperative values. No cerebral hemorrhage was found in our series during hospitalization. Of 107 CEAs followed up, eight had restenosis (≥50%) detected with ultrasonography within 6-8 months after CEA. Within 30 days after CEA for 116 CEAs, the morbidity rate was 1.7 % (3.1% in the symptomatic arm and 1.2% in the asymptomatic arm) and mortality was 0.0%. The morbidity demonstrated two ischemic strokes and no MI in this series. Our method of CEA proved to be a safe and efficient for treatment of carotid artery stenosis.
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Yoneyama et al. (2012) conducted an observational in Carotid artery stenosis (n=121). Carotid endarterectomy was evaluated on 30-day morbidity (any stroke, myocardial infarction) and mortality. Carotid endarterectomy performed by a two-surgeon team resulted in a low 30-day morbidity rate of 1.7% and 0.0% mortality, demonstrating safety for treating carotid artery stenosis.
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