[Carotid endarterectomy: description, results and clinic evolution in 100 consecutive symptomatic patients].
BACKGROUND
The efficacy of endarterectomy in symptomatic carotid stenosis greater than 70% in secondary stroke prevention has been demonstrated although the benefit is dependent upon the perioperative morbidity and mortality risk. Despite the recommendation that the results of centres regularly practicing endarterectomies be analysed and reported, few studies have in fact been published. The aim of our study was to analyze the incidence of surgical complications from carotid endarterectomy at our hospital and to describe the stroke profile of the operated patients.


METHODS
100 consecutive patients submitted to carotid endarterectomy between 2002 and 2006 were included. We recorded stroke risk factors, clinical presentation, ultrasonography findings including transcranial and carotid eco-Doppler, neuroimaging, intra and perioperative complications including mortality- stroke rate, and clinical outcome at three months. We compare our results with the NASCET, ECST and Spanish published series.


RESULTS
Males predominated (74 % vs 26 %). The mean age was 70+/-8.5 years with 36 % of patients older than 75 years. Arterial hypertension was the most common vascular risk factor (74%), 14% had a critical contralateral carotid stenosis or occlusion. Stroke was the most frequent clinical presentation (67 %). The most commonly detected intraoperatory and postoperatory complication was subclinical haemodynamic changes (67% and 45% respectively). Cranial nerve lesions were the most usual local complication. Four patients suffered stroke recurrence, leading to death in one. A further patient died due to a reperfusion syndrome. The rate of stroke-mortality at three months was 5%.


CONCLUSIONS
Morbidity and mortality related to carotid endarterectomy for symptomatic stenosis greater than 70 % was within guideline ranges. Surgical risk at every centre should be periodically evaluated in order to guarantee that acceptable standards are maintained.
Martínez Fernández
Raúl
R
Servicio de Neurología, Institut d'investigació biomèdica de Girona, Hospital Doctor Josep Trueta, Girona. raulrail@hotmail.com
Silva
Y
Y
Gómez
E
E
Amado
J
J
Sanjuán
E
E
Serena
J
J
D000368:Aged; D000369:Aged, 80 and over; D016893:Carotid Stenosis / Q000601:surgery*; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012307:Risk Factors; D016896:Treatment Outcome