title: Carotid endarterectomy: results and long-term follow-up of a single institution.
abstract: OBJECTIVE
  To document our experiences, technical procedure and outcomes of carotid endarterectomy (CEA) in patients with symptomatic carotid stenosis.
  
  
  METHODS
  A total of 49 consecutive patients underwent 53 CEAs (three bilateral, one redo) for severe carotid artery stenosis. There were 39 males and 10 females, with mean age of 63 years. All patients underwent neck Doppler, computed tomography/magnetic resonance angiography/digital substraction angiography and a detailed cardiological evaluation. Antiplatelet drugs were continued perioperatively. Surgery was performed under general anesthesia with propofol cerebral protection, mild hypothermia and continuous electroencephalogram monitoring. The procedure was done under microscope and closure was done using 6-0 prolene. Clinical and radiological follow-up was done.
  
  
  RESULTS
  Our mean follow-up was 4.69 years. All patients underwent primary suturing except one redo CEA done with venous patch graft. Three patients required intraoperative shunting. One patient died secondary to myocardial infarction peroperatively prior to carotid manipulation. One patient had stroke within 6 h, secondary to operative site intraluminal thrombus and was re-explored. Two patients had transient postoperative hemiparesis and aphasia while two patients had altered sensorium, all self-limiting, with normal imaging. One patient developed temporary twelfth-nerve paresis. One patient had persistent transient ischemic attack on the follow-up. Thus, the perioperative mortality rate was 1.89% and stroke rate was 1.89%.
  
  
  CONCLUSIONS
  CEA for severe carotid stenosis is a safe procedure with good protection from ischemic events. Detailed preoperative cardiac evaluation and appropriate patient selection is essential.
authors: Department of Neurosurgery, Gamma Knife Radiosurgery, P. D. Hinduja National Hospital and Medical Research Centre, Mumbai, India. basantkmisra@gmail.com
authors: Basant K
authors: BK
authors: Misra
authors: Harshad R
authors: HR
authors: Purandare
authors: Rahul
authors: R
authors: Ved
authors: P P
authors: PP
authors: Ashok
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000768:Anesthesia, General; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D056805:Consciousness Monitors; D004569:Electroencephalography; D016894:Endarterectomy, Carotid / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced; D002546:Ischemic Attack, Transient / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D040242:Risk Reduction Behavior; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D010975:Platelet Aggregation Inhibitors