1. Carotid surgery: a historic perspective.
The development of the appropriate role for surgery on the carotid artery has mirrored many other advances in the field of health care. The acceptance of this intervention has differed amongst specialties, and only recently has undeniable evidence of its efficacy been presented. The invention of carotid angiography established a direct link between plaque at the carotid bifurcation and stroke. The operations steadily gained popularity from 1971, when 17,000 procedures were performed, until the mid-1980s, when over 100,000 procedures were performed in North America. The North American Symptomatic Carotid Endarterectomy Trial was initiated to test the question of whether adding carotid endarterectomy to maximum medical therapy reduces the risk of stroke in patients with focal temporary neurologic deficits. Canadian vascular surgeons embraced this study with enthusiasm and contributed to the successful completion of the first part of the trial. The role for surgery in those patients who fit into the study categories is clear, but a need for surgical judgement exists for other groups of patients and must remain a pivotal tool for directing surgical intervention.
Walker
P M
PM
Department of Surgery, University of Toronto, Toronto Hospital, Ont.
D002340:Carotid Artery Diseases / Q000266:history* / Q000601:surgery; D016894:Endarterectomy, Carotid / Q000266:history*; D049673:History, 20th Century; D006801:Humans; D009656:North America