Carotid endarterectomy

Most common peripheral vascular procedure performed in the U.S. today.

Nearly 100,000 procedures each year in the United States.

Reduces stroke in patients with a 70% degree of stenosis or greater compared to medical management.

Surgery is of some benefit for patients with 50-69% symptomatic stenosis.

In asymptomatic stenosis endarterectomy of marginal benefit with 20 patients having to undergo surgery to prevent one stroke over 5 years.

Patients with a previous stroke or TIA and with severe (70-99%) carotid stenosis should undergo surgery.

Low complication rate with morbidity and mortality less than 6%.

Early postoperative mortality rate of only 1.6%.

Hospital stay averages 2 days in most centers.

Perioperative risk of stroke rates approximating 2% or less.

Restenosis occurs in roughly 5% of patients during the first year after endarterectomy and averages about 2% per year thereafter.

60% decrease in mortality when procedure performed by high-volume surgeons compared with low-volume surgeons, and a 30% decrease compared to medium-volume surgeons.

Decrease in postoperative stroke by 45% and 33% when treatment provided by a high-volume surgeon compared to a low-volume and medium-volume surgeons, respectively.

Cranial and cervical nerve injuries occur in 7.6-22% of patients.

Patients with contralateral carotid stenosis or advanced cardiac disease poor candidates for endarterectomy.

Patients with complete obstruction of the internal carotid artery have a minimal risk for emboli and are generally are not candidates for endarterectomy.

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