title: Carotid endarterectomy remains the gold standard.
abstract: BACKGROUND
  To compare the safety and efficacy of carotid endarterectomy (CEA) as performed in a community medical center with the Asymptomatic Carotid Atherosclerosis Study (ACAS) and North American Symptomatic Carotid Endarterectomy Trial (NASCET) standards and with representative published results regarding carotid angioplasty and stenting (CAS).
  
  
  METHODS
  Between 1 January 1994 and 31 July 2000, 267 CEA procedures were performed on 236 patients at Madigan Army Medical Center (MAMC). Prospectively acquired patient demographics, operative indications, and surgical outcomes were reviewed using clinical records, carotid duplex evaluations, and follow-up examinations. The resultant data were compared with ACAS, NASCET, and published results of CAS.
  
  
  RESULTS
  The perioperative stroke rate was 2.2% (6 of 267) overall, 0.7% (1 of 139) among asymptomatic patients, and 3.9% (5 of 128) among symptomatic patients. There were no perioperative deaths from any cause in the entire series. The respective ACAS and NASCET early stroke-death rates were 2.3% (19 of 825) and 5.8% (19 of 328). The largest published series of CAS reported stroke-death rates of 5.7% (299 of 5,210) overall, and 3.4% (46 of 1,361) and 5.8% (93 of 1,614) for asymptomatic and symptomatic patients, respectively.
  
  
  CONCLUSIONS
  CEA remains the standard of care. It is a safe, effective, and durable procedure that can be performed in a facility such as MAMC with outcomes that compare favorably with ACAS and NASCET. Results of CEA at MAMC are superior to similar data regarding CAS. Widespread use of CAS should be deferred pending completion of on-going prospective trials versus CEA.
authors.affiliation: Department of General Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.
authors.forename: Philip S
authors.initials: PS
authors.lastname: Mullenix
authors.forename: Charles A
authors.initials: CA
authors.lastname: Andersen
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Olsen
authors.forename: David F J
authors.initials: DF
authors.lastname: Tollefson
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex