Available online 5 March 2013
Publication year: 2013
Source:World Neurosurgery
Objective Carotid endarterectomy (CEA) is a procedure performed both by vascular surgeons and neurosurgeons in the UK. We present a single neurosurgeon's experience of 728 CEAs over 25 years, performed under both GA and LA and discuss the results in the context. Our objective was to report on the efficacy of CEA in the hands of a neurosurgeon. Methods Prospective outcome data were collected for all the patients that underwent CEA performed by the senior author (ADM) from 1987 to 2011. Data evaluated included patient age, sex, surgical indication, pre-operative characteristics, diagnostic modalities used, shunt usage, operative time, any neurological deterioration during or after surgery and early postoperative problems. 30-day death and 30-day disabling stroke were used as outcome measures. The results were tabulated and analysed using JMP 8.0.2 (SAS Inc, Cary, NC). Results The 30-day death rate was 0.8% and the 30-day disabling stroke rate was 1.7% in our series. The mean operative time was 135 min(±38.1) and the mean clamp time was 28.4min(±8.5). In the subset of patients who had the operation performed under LA (n=616) the disabling stroke rate was 1.6% and the death rate was 0.6%. In the subset of asymptomatic patients (n=194) the 30-day death and 30-day disabling stroke rate were each 1%. Postoperative complications were uncommon. Conclusions According to our data, CEA under LA is safe procedure in the hands of a neurosurgeon and would be recommended as per the clinical presentation and local guidelines.
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