title: Carotid endarterectomy—safe and effective in a neurosurgeon's hands: a 25-year single-surgeon experience.
abstract: OBJECTIVE
  Carotid endarterectomy (CEA) is a procedure performed by both vascular surgeons and neurosurgeons in the UK. We present a single neurosurgeon's experience of 728 CEAs over 25 years, performed under both general and local anesthesia, and discuss the results in this context. Our objective was to report on the efficacy of CEA in the hands of a neurosurgeon.
  
  
  METHODS
  Prospective outcome data were collected for all patients who underwent CEA performed by the senior author (A.D.M.) from 1987 to 2011. Data evaluated included patient age, sex, surgical indication, preoperative characteristics, diagnostic modalities used, shunt usage, operative time, any neurological deterioration during or after surgery, and early postoperative problems. Outcome measures used were 30-day death and 30-day disabling stroke. The results were tabulated and analyzed using JMP 8.0.2 (SAS Inc., Cary, NC).
  
  
  RESULTS
  The 30-day death rate was 0.8% and the 30-day disabling stroke rate was 1.7% in our series. The mean operative time was 135 minutes (±38.1), and the mean clamp time was 28.4 minutes (±8.5). In the subset of patients who had the operation performed under local anesthesia (n = 616), the disabling stroke rate was 1.6% and the death rate was 0.6%. In the subset of asymptomatic patients (n = 194), the 30-day death and 30-day disabling stroke rates were each 1%. Postoperative complications were uncommon.
  
  
  CONCLUSIONS
  According to our data, CEA under local anesthesia is safe procedure in the hands of a neurosurgeon and would be recommended according to the clinical presentation and local guidelines.
authors.affiliation: The James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Nitin
authors.initials: N
authors.lastname: Mukerji
authors.affiliation: The James Cook University Hospital, Middlesbrough, United Kingdom.
authors.forename: Kuskoor Seetharam
authors.initials: KS
authors.lastname: Manjunath Prasad
authors.affiliation: The Neurosurgery Clinic, Guatemala City, Guatemala.
authors.forename: Ramon
authors.initials: R
authors.lastname: Vivar
authors.affiliation: Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. Electronic address: a.d.mendelow@ncl.ac.uk.
authors.forename: Alexander David
authors.initials: AD
authors.lastname: Mendelow
mesh_terms: D000368:Aged; D000768:Anesthesia, General / Q000191:economics; D000772:Anesthesia, Local / Q000191:economics; D003362:Cost-Benefit Analysis; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009493:Neurosurgery / Q000191:economics / Q000706:statistics & numerical data*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control; D066231:Surgeons; D016896:Treatment Outcome
keywords: CEA; Neurosurgeon; Stroke