Durability of carotid endarterectomy.
OBJECTIVE
We sought to determine the incidence of recurrent stenosis after carotid endarterectomy.


METHODS
One thousand consecutive carotid endarterectomy patients were followed prospectively. The surgery was performed in a standard fashion. Cerebral protection was provided with intraoperative electroencephalographic monitoring and selective shunting. All arteriotomies were repaired with a patch graft. Each patient was seen 3 months after surgery and then yearly, with a duplex ultrasound obtained at each visit. Evidence for new ischemic events or recurrent stenosis of >or=70% was recorded.


RESULTS
The 30-day combined minor and major stroke and death rate was 1.9%. At 7.1-year follow-up, 0.1% of patients had recurrent stenosis >or=70%, the majority of which were asymptomatic.


CONCLUSIONS
Carotid endarterectomy is a low-risk procedure for the treatment of carotid occlusive disease, with excellent long-term durability. Although less invasive, carotid angioplasty must demonstrate equal robustness in long-term follow-up before it is considered a routine alternative to surgery.
Ecker
Robert D
RD
Department of Neurosurgery, Mayo Clinic and Foundation, Rochester, MN 55905, USA.
Pichelmann
Mark A
MA
Meissner
Irene
I
Meyer
Fredric B
FB
D000368:Aged; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000175:diagnosis / Q000000981:diagnostic imaging; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008910:Minnesota; D011446:Prospective Studies; D012008:Recurrence; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D014463:Ultrasonography