Carotid endarterectomy 20-year experience in a low-volume center

Introduction: Carotid endarterectomy (CEA) is the first choice in the treatment of extracranial carotid occlusive disease but exists the controversy if this surgical procedure must be done just in center of high volume. Objective: The aim of the study is to assess if it is safe to perform CEA in a low-volume center and trying to answer some controversial questions about the preoperative, transoperative, and postoperative management. Design: This was a retrospective and observational case study. Patients and Methods: Details of 328 consecutive patients operated upon for carotid stenosis from September 1998 to December 2018 were analyzed. Results: Perioperative mortality was 0%. Perioperative neurological morbidity was 0.6% with major strokes and 1.2% minor strokes and transient lesions of cranial nerves were 4%, and there was no reoperation for bleeding or thrombosis. Conclusion: The zero percent mortality and low complication rate in our hospital are related to improved preoperative patients' evaluation, surgeons' increasing experience, and to surgical and anesthesiologic technique, so following a strict protocol, performing a CEA in a low-volume center is safe.