Durability of Carotid Endarterectomy

Keywords: carotid artery, outcome, endarterectomy, stroke, ischemia

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     Carotid endarterectomy has been demonstrated as a low risk treatment for carotid occlusive disease. Some studies have suggested that carotid angioplasty may be a competitive alternative. What has not been fully considered however is the risk of recurrent stenosis following either intervention.
     The purpose of this study is to provide outcome data and cost analysis of the durability of carotid endaraterectomy.
     1,492 sequential patients (a total of 1,649 endarterectomies) at Saint Mary’s Hospital in Rochester, Minnesota from 1988 to 2010 were followed prospectively with carotid ultrasonography on an annual basis.
     All patients were maintained on antiplatelet therapy postoperatively and all arteriomoties were closed secondarily with a patch graft. Each operation was performed with intraoperative EEG monitoring and selective shunting. Calculation of cost was also performed.
     Two thirds of the patients were men and the mean age was 71. The mean follow-up was 15.8 years. Approximately 60% were symptomatic. The 30 day perioperative stroke rate was 0.3% (n=5) and mortality was 0.4% (n=7). The total morbidity and mortality for the entire cohort was under 1.0%. There were 5 cervical hematomas requiring exploration without sequaelae. Five patients (0.3%) developed recurrent stenosis greater than 70%. The cost for carotid endarterectomies is approximately $200-400 less than stenting per procedure.
     This is a retrospective study.
     This data confirms that carotid endarterectomy is a safe treatment for carotid stenosis with low periprocedural risk.
     It is also evident that the durability of surgery is excellent with an extremely low risk for recurrent stenosis. When comparing endarterectomy with angioplasty, durability of the intervention needs to be considered health care costs and incidence of carotid occlusive disease.


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