title: Carotid Endarterectomy: experience in 8743 cases.
abstract: BACKGROUND
  Recently published case series of patients undergoing carotid endarterectomy suggested a reduction in the rate of perioperative neurologic events when compared to those reported in the large randomized trials performed in the 1990s, without great differences between high and low risk patients.
  
  
  METHODS
  As a major center of Vascular Surgery we prospectively collected data on 8743 carotid endarterectomy procedures (eversion technique 75%, patch closure 17.5%) performed in the period 1992-2009.
  
  
  RESULTS
  Perioperative mortality was 0.32% (27/8743) with myocardial infarction being the most frequent cause (9 patients). Perioperative neurological morbidity was 1.04% (91/8743) with 51 major and 40 minor strokes. In 201 cases (2.3%) a cervical hematoma (suture-line bleeding in 41 cases and or diffuse oozing in 160 cases) in the early postoperative period necessitated urgent wound revision. In 262 (3.0%) cases we observed permanent or transient lesions of cranial nerves in the postoperative period. There was no significant difference in the combined ipsilateral stroke and perioperative death rate in octogenarian patients (2.1% in octogenarians and 1.2% in younger patients, p>0.05), even though an increasing trend was evident.
  
  
  CONCLUSIONS
  Carotid endarterectomy has a reduced rate of perioperative complications when compared to those previously reported in literature. The low complication rate is related to improved preoperative patients evaluation, surgeons' increasing experience and to surgical and anesthesiological techniques. Carotid angioplasty and stenting should have their results compared to these real world results of carotid endarterectomy in order to asses their reliability when treating extracranial cerebrovascular disease.
authors: Department of Vascular Surgery, San Raffaele Scientific Institute, Università Vita-Salute, Milan, Italy.
authors: R
authors: R
authors: Chiesa
authors: G
authors: G
authors: Melissano
authors: R
authors: R
authors: Castellano
authors: Y
authors: Y
authors: Tshomba
authors: E M
authors: EM
authors: Marone
authors: E
authors: E
authors: Civilini
authors: D
authors: D
authors: Astore
authors: F
authors: F
authors: Calliari
authors: B
authors: B
authors: Catenaccio
authors: G
authors: G
authors: Coppi
authors: A
authors: A
authors: Carozzo
authors: R
authors: R
authors: Mennella
keywords: carotid endarterectomy; stroke survival anesthesia; vascular surgery