Carotid Endarterectomy in the Patients with High Risk Clinical Factors

Abstract

In the recent large randomized trials performed in North America and Europe, the beneficial effects of and guidelines for carotid endarterectomy (CEA) were reconfirmed for both symptomatic and asymptomatic patients with high-grade carotid artery stenosis. These benefits can be realized only if perioperative mortality and morbidity are minimized. Clinical risk factors associated with an increased incidence of perioperative complications from CEA have been categorized into several groups, and Sundt et al. identified general medical, neurologic, and angiographically defined risk factors. Here we review the previous reports and our experiences, and present some clinical risk factors to identify patients with increased risk of perioperative events. Indication and surgical techniques in these patients with high risk factors are also discussed.