A Defined Protocol and Result of CEA Performed by Expert Surgeons and Beginner Surgeons: Our Hospital Case

Abstract

In April 2008, carotid artery stenting (CAS) was approved for high-risk candidates for carotid endarterectomy (CEA) in Japan, a difficult procedure for young neurosurgeons. From January 2001 to March 2008, in our hospital, CEA was performed on 68 vessels by 2 expert surgeons and 234 vessels by 10 beginner surgeons with a defined protocol. This protocol includes propofol anesthesia with electroencephalography (EEG) and somatosensory evoked potential (SEP) monitoring, the avoidance of an intraluminal shunting, brain protection, and strict control of postoperative hypertention. At 30 days, combined permanent mortality and morbidity rate was 2.9% in the experts’ group and 0.9% in the beginners’ group. We report a series of 302 consecutive CEAs performed by 2 expert and 10 beginner surgeons within a defined protocol and the results.