2002 Volume 30 Issue 6 Pages 450-455
International cooperative studies have almost established carotid endarterectomy (CEA) as the surgical treatment for carotid artery stenosis to prevent cerebral infarction. However, the procedure's success depends on ability of a surgeon's technique and perioperative control with complication under 3% for aymptomatic stenosis. There is little experience with CEA in Japan, so reports of long-term follow-up studies are rare. We have performed CEA with a stable team for the past 17 years, and review surgical outcomes and follow-up results.
The mean age of 203 CEAs was 64. There were 175 men. We have routinely used a shunt system and intraoperative monitoring under general anesthesia. These patients were followed up for 6.5 years on average, and a change of ADL was evaluated with Glasgow Outcome Scale.
Four patients (2.0%) showed neurological deficits such as hemipapresis. The causes were cerebral embolism, wound hemorrhage, cerebral ischaemia by carotid artery hemostasis, and hyperperfusion syndrome. However, all of them were seen in the initial period of more than 10 years before. Mortality was 0%. One hundred and sixty patients were followed up for more than a year. Three patients had re-stenosis and occlusion of the operated internal carotid artery, and 2 of them were operated on again while asymptomatic. Four patients (2.5%) had ischemic attack in the operated side, but all of the lesions were at intracranial sites. Aggravation of ADL was recognized in 28 patients with no carotid lesions. There were 19 deaths, 10 of which were caused by cancers. Twenty-seven patients had ischemic heart diseases, 6 of whom died.
CEA is effective for prevention of cerebral infarction, when practiced surgeons perform with intraoperative monitoring. However, general examination and treatment with cardiologists are necessary, because patients often have cardiovascular diseases.
