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A Journal on Vascular and Endovascular Surgery

Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2000 September;7(3):215-24

language: English, Italian

Carotid endarterectomy (Institutional experience over the past ten years)

Pulli R., Dorigo W., Barbanti E., Izzo F., Turini F., Azas L., Pratesi C.

From the Department and School of Specialisation in Vascular Sugery University of Florence, Italy


Background. To eval­u­ate chang­es in the indi­ca­tions, tac­tics and sur­gi­cal tech­nique ­over the ­course of the ­past ten ­years in extra­cra­ni­al carot­id ­artery sur­gery.
Methods. A ­total of 2309 carot­id endar­te­rec­to­my oper­a­tions ­were per­formed ­between 1 January 1990 and 31 December 1998. A pros­pec­tive ­study was ­made, insert­ing ­patient ­data at the ­time of the oper­a­tion in a spe­cial ­data ­base. Special atten­tion was ­paid to age, pre­op­er­a­tive neu­ro­log­i­cal symp­toms, the ­degree of sten­o­sis of the oper­at­ed carot­id, intra­op­er­a­tive mon­i­tor­ing, the ­type of recon­struc­tion, per­i­op­er­a­tive mor­tal­ity and neu­ro­log­i­cal mor­bid­ity.
Results. We ­found ­that con­sid­er­able chang­es ­have tak­en ­place in ­terms of: Age: approx­i­mate­ly 5% of the ­patients oper­at­ed dur­ing the sec­ond ­half of the 90s ­were >80, where­as in the ear­ly 90s octo­ge­nar­ians ­were excep­tion­al cas­es; Indications: In the ­past few ­years the indi­ca­tions ­referred ­almost exclu­sive­ly to sten­o­sis >60%. During the ­past two ­years, the per­cent­age of asymp­to­mat­ic sub­jects exceed­ed 50% of our ­series ­where asymp­to­mat­ic ­refers to a ­patient with­out spe­cif­ic neu­ro­log­i­cal symp­toms dur­ing the 6 ­months ­prior to sur­gery; Type of recon­struc­tion: the use of a patch angioplasty was wide­ly pre­ferred; Intraoperative mon­i­tor­ing and cere­bral pro­tec­tion: the use of SEP has ­reduced the inci­dence of ­shunt use to ­below 10%.
The ­results in ­terms of mor­tal­ity and ­major neu­ro­log­i­cal mor­bid­ity ­were sat­is­fac­to­ry, and ­almost ­always ­remained ­below the 2% thresh­old.
Conclusions. In our expe­ri­ence a num­ber of ­aspects of carot­id sur­gery ­have ­changed dur­ing the 1990s. These chang­es did not influ­ence our ­results in ­terms of mor­tal­ity and neu­ro­log­i­cal mor­bid­ity. There are pre­cise indi­ca­tions for sur­gery in ­patients affect­ed by hemo­dy­nam­ic sten­o­sis of the extra­cra­ni­al carot­id. Surgery may ­also be ­used in ­over-80-­year-­olds and in asymp­to­mat­ic ­patients, pro­vid­ed ­that the ­results are sat­is­fac­to­ry.

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