21 Carotid Endarterectomy

Ephraim W. Church and Scott D. Simon

Abstract

Carotid stenosis is an important risk factor in ischemic stroke, and without surgery the risk of stroke is approximately 26% at 2 years for symptomatic patients and 11% at 5 years for asymptomatic patients. The first carotid endarterectomies (CEA) were performed in the 1950s to 1960s. Initial high morbidity and mortality decreased as experience grew, and it was called a “glimmering science.” Today, morbidity from CEA is in the 3 to 5% range with modern surgical technique. In this chapter, we review the pathophysiology of carotid stenosis and the history of CEA. We then discuss our technique in detail including complication avoidance and management. Key to successful carotid stenosis management and CEA is patient selection. We end the chapter with a thorough discussion of patient selection for both symptomatic and asymptomatic patients. Endarterectomy for symptomatic carotid stenosis decreases the 5-year stroke risk from 26 to 9% (number needed to treat 6), placing it among the most effective stroke treatments currently available.

Key words

ischemic stroke - symptomatic carotid stenosis - asymptomatic carotid stenosis - carotid endarterectomy - surgical technique

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