title: The practice of carotid endarterectomy in a large metropolitan area.
abstract: All carotid endarterectomies performed in the greater Cincinnati metropolitan area during 1980 were reviewed. For the 431 procedures performed in 16 hospitals, the operative stroke rate was 8.6% (37 of 431), and the operative mortality rate was 2.8% (12 of 431). The combined morbidity and mortality was 9.5% (41 of 431). Fifty percent of the procedures were done for asymptomatic carotid disease (216 of 431) and 50% were done for symptomatic carotid disease (215 of 431). The stroke rate was 5.6% for the asymptomatic patients and 11.6% for the symptomatic patients (difference significant, p less than 0.05). Neurosurgeons and vascular surgeons had similar surgical morbidity. All of the operative strokes involved the hemisphere ipsilateral to the endarterectomy. Fifty-seven percent of the operative strokes (21 of 37) occurred after a neurologically intact interval lasting hours to days. Four occurred following combined endarterectomy-coronary bypass surgery, and one was an intracerebral hemorrhage. The other late strokes (17) occurred without evidence for cardiac embolus or hemorrhage, consistent with a thrombogenic-embologenic operative site, and raising the question of need for adjunctive perioperative medical therapy.
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001314:Auscultation; D002339:Carotid Arteries / Q000601:surgery*; D002340:Carotid Artery Diseases / Q000601:surgery; D002544:Cerebral Infarction / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000517:prevention & control; D003251:Constriction, Pathologic; D004244:Dizziness / Q000517:prevention & control; D004691:Endarterectomy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006769:Hospitals, General; D006801:Humans; D002546:Ischemic Attack, Transient / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009820:Ohio