title: Experiences with carotid endarterectomy at Sree Chitra Tirunal Institute.
abstract: BACKGROUND
  Atherosclerotic carotid artery disease poses a grave threat to cerebral circulation, leading to a stroke with its devastating sequelae, if left untreated. Carotid endarterectomy has a proven track record with compelling evidence in stroke prevention.
  
  
  OBJECTIVE
  a) To confirm that carotid endarterectomy (CEA) is safe and effective in preventing stroke at both short and long term. b) to demonstrate long term patency of internal carotid artery when arteriotomy repair is performed using autologous saphenous vein patch.
  
  
  METHODS
  During ten years, from September 1997 to February 2008, thirty nine patients who underwent consecutive carotid endarterectomy at our institute, form the basis of this report. Their age ranged from thirty to seventy eight years, with a mean age of 56. There were four women in this cohort. Thirty seven patients were symptomatic with >70% stenosis and two were asymptomatic with >80% stenosis, incidentally detected. Imaging included Duplex scan and MRA for carotid territory and brain, and non-invasive cardiac assessment. Co-morbidities included smoking, hypertension, diabetes, and coronary artery disease. Carotid Endarterectomy was performed under general anaesthesia, using carotid shunt and vein patch arteriotomy repair.
  
  
  RESULTS
  All the patients made satisfactory recovery, without major adverse cerebral events in this series. Morbidities included Transient Ischemic Attack (TIA) in two, needing only medications in one, and carotid stenting in the other. Minor morbidities included neck hematoma in two and transient hypoglossal paresis in three patients. Yearly follow-up included duplex scan assessment for all the patients. Two patients died of contralateral stroke, two of myocardial events and two were lost to follow up. Thirty three patients are well and free of the disease during the follow up of three to 120 months.
  
  
  CONCLUSIONS
  Carotid endarterectomy provided near total freedom from adverse cerebral events and its catastrophic sequelae, leading to excellent outcome, both short as well as long term.
authors.forename: Madathipat
authors.initials: M
authors.lastname: Unnikrishnan
authors.forename: Shivananda
authors.initials: S
authors.lastname: Siddappa
authors.forename: Rajesh
authors.initials: R
authors.lastname: Anto
authors.forename: Vivek
authors.initials: V
authors.lastname: Babu
authors.forename: Benny
authors.initials: B
authors.lastname: Paul
authors.forename: Thirur Raman
authors.initials: TR
authors.lastname: Kapilamoorthy
authors.forename: Sivasubramanian
authors.initials: S
authors.lastname: Sivasankaran
authors.forename: Samavedam
authors.initials: S
authors.lastname: Sandhyamani
authors.forename: Rupa
authors.initials: R
authors.lastname: Sreedhar
authors.forename: Kuruppath
authors.initials: K
authors.lastname: Radhakrishnan