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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
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.