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Carotid Endarterectomy in Symptomatic Extracranial Internal Carotid Artery Stenosis: A Result of the First 100 Consecutive Cases in a University Hospital.

Background
Extracranial carotid artery stenosis has been recognized in 9.2% of ischemic stroke patients by duplex ultrasonography in Thailand. The treatment program of this disease has not been established countrywide.


Objective
Carotid endarterectomy in our institute was firstly evaluated for safety and long-term efficiency in order to assess the possibility of expanding this treatment throughout the country.


Material and Method
An observational study with long-term follow-up was carried out in 100 consecutive symptomatic patients with severe stenosis (70-99% diameter stenosis) of extracranial internal carotid artery that underwent carotid endarterectomies. All carotid endarterectomies were performed under general anesthesia, with routine use of intravascular shunts during carotid cross clamps and saphenous vein patches for arteriotomy closures. Perioperative mortality and morbidity were evaluated for the safety of this procedure. The long-term stroke-free survival was assessed to announce the efficiency of this treatment.


Results
One hundred consecutive patients (68% male and 32%female) with the mean age of 69.9 years were included in the present study. Mean duration of neurological symptoms prior to surgery was 2.5 months. Hemiplegia (64%) was the most common symptom leading to surgery. Hypertension (87%) was the most common comorbidity in the present series. Mean duration of surgical procedure was 210 minutes. Mean durations of total carotid shunting and carotid cross clamp during shunt removal were 75 minutes and 4.5 minutes respectively. Mean length of ICU stay was 1.4 days. The perioperative mortality rate was 1%. The perioperative major stroke rate was also 1%. Ten-year follow-up of the patients revealed no death related to neurovascular event and no evidence of recurrent ipsilateral stroke in the present series. The cumulative 5- and 10-year stroke-free survivals were 86.1% and 73.7% respectively. Duplex ultrasonography in all survivors demonstrated no recurrent stenosis in the affected carotid artery.


Conclusion
Carotid endarterectomy with a consistent technique in the present series had a comparable outcome of safety and long-term efficiency with the standard surgical practice. The information may initiate the treatment guideline for the patient with extracranial carotid artery stenosis in Thailand.