Changing characteristics of carotid endarterectomy

We have noted significant differences in terms of our preoperative work-up, length of stay, morbidity, and mortality of patients undergoing carotid en darterectomy (CEA) from findings reported in large published randomized cli nical trials. To further investigate these differences, we have reviewed ou r recent experience. CEA has proved to be the most effective approach to av ert stokes caused by significant atherosclerotic disease of the carotid bif urcation. Between January 1, 1996 and December 31, 1998, 552 patients under went CEA at our institution. Forty percent were performed in symptomatic pa tients with stenotic lesions >60% in diameter by duplex ultrasonography. Th e remainder were performed for asymptomatic lesions >60% in diameter. No pa tient underwent contrast angiography. Fifty-two percent of the patients wer e males. The mean age was 74 +/- 8 years old. General anesthesia was used i n 97% of the cases and regional block, in 3%. All patients underwent routin e postoperative measurement of serum creatinine phosphokinase (CPK) isoenzy mes. Patients were discharged when deemed clinically stable. The patients' follow-up visits at 1 week and at 3-5 months after the procedure (mean, 3.4 months) included a neurological exam and duplex exam. Patient results sugg est that CEAs can be performed in the modern era without contrast arteriogr aphy. Most patients can be discharged on the first postoperative day. In ad dition, previously acceptable rates of postoperative morbidity and mortalit y should perhaps be revised to meet current standards. Contrary to the prev ious concept that most postoperative strokes are due to embolic phenomena, hyperperfusion syndrome played an increasingly important role in this revie w.