Stroke, Vol 15, 950-955, Copyright © 1984 by American Heart Association
T Brott and K Thalinger
All carotid endarterectomies performed in the greater Cincinnati
metropolitan area during 1980 were reviewed. For the 431 procedures
performed in 16 hospitals, the operative stroke rate was 8.6% (37 of 431),
and the operative mortality rate was 2.8% (12 of 431). The combined
morbidity and mortality was 9.5% (41 of 431). Fifty percent of the
procedures were done for asymptomatic carotid disease (216 of 431) and 50%
were done for symptomatic carotid disease (215 of 431). The stroke rate was
5.6% for the asymptomatic patients and 11.6% for the symptomatic patients
(difference significant, p less than 0.05). Neurosurgeons and vascular
surgeons had similar surgical morbidity. All of the operative strokes
involved the hemisphere ipsilateral to the endarterectomy. Fifty-seven
percent of the operative strokes (21 of 37) occurred after a neurologically
intact interval lasting hours to days. Four occurred following combined
endarterectomy-coronary bypass surgery, and one was an intracerebral
hemorrhage. The other late strokes (17) occurred without evidence for
cardiac embolus or hemorrhage, consistent with a thrombogenic-embologenic
operative site, and raising the question of need for adjunctive
perioperative medical therapy.
ARTICLES
The practice of carotid endarterectomy in a large metropolitan area
This article has been cited by other articles:
 |
|
 |
|
  R. T. Higashida, P. M. Meyers, C. C. Phatouros, J. J. Connors III, J. D. Barr, D. Sacks, and for the Technology Assessment Committees of the Am Reporting Standards for Carotid Artery Angioplasty and Stent Placement Stroke, May 1, 2004; 35(5): e112 - e134. [Full Text] [PDF]
|
|
|
|
|
|
R. Bond, K. Rerkasem, and P.M. Rothwell Systematic Review of the Risks of Carotid Endarterectomy in Relation to the Clinical Indication for and Timing of Surgery Stroke, September 1, 2003; 34(9): 2290 - 2301. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Halm, M. R. Chassin, S. Tuhrim, L. H. Hollier, A. J. Popp, E. Ascher, H. Dardik, G. Faust, and T. S. Riles Revisiting the Appropriateness of Carotid Endarterectomy Stroke, June 1, 2003; 34(6): 1464 - 1471. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. A. Halm, C. Lee, and M. R. Chassin Is Volume Related to Outcome in Health Care? A Systematic Review and Methodologic Critique of the Literature Ann Intern Med, September 17, 2002; 137(6): 511 - 520. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. L. Hannan, A. J. Popp, P. Feustel, E. Halm, G. Bernardini, J. Waldman, D. Shah, and M. R. Chassin Association of Surgical Specialty and Processes of Care With Patient Outcomes for Carotid Endarterectomy Stroke, December 1, 2001; 32(12): 2890 - 2897. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. C. Phatouros, R. T. Higashida, A. M. Malek, P. M. Meyers, T. E. Lempert, C. F. Dowd, and V. V. Halbach Carotid Artery Stent Placement for Atherosclerotic Disease: Rationale, Technique, and Current Status Radiology, October 1, 2000; 217(1): 26 - 41. [Abstract] [Full Text]
|
|
|
|
 |
|
 L. O'Neill, D. J. Lanska, and A. Hartz Surgeon characteristics associated with mortality and morbidity following carotid endarterectomy Neurology, September 26, 2000; 55(6): 773 - 781. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J. Connors III, D. Seidenwurm, J. C. Wojak, R. W. Hurst, M. E. Jensen, R. Wallace, T. Tomsick, J. Barr, C. Kerber, E. Russell, et al. Treatment of Atherosclerotic Disease at the Cervical Carotid Bifurcation: Current Status and Review of the Literature AJNR Am. J. Neuroradiol., March 1, 2000; 21(3): 444 - 450. [Full Text]
|
|
|
|
 |
|
 L. B. Goldstein, J. L. Saver, J. S. Elkins, P. G. Shekelle, R.E. Park, M. R. Chassin, R. B. Haynes, H. J.M. Barnett, D. W. Taylor, and J. V. Tu Carotid Endarterectomy N. Engl. J. Med., April 15, 1999; 340(15): 1209 - 1212. [Full Text]
|
|
|
|
|
|
H. J.M. Barnett, D. W. Taylor, M. Eliasziw, A. J. Fox, G. G. Ferguson, R. B. Haynes, R. N. Rankin, G. P. Clagett, V. C. Hachinski, D. L. Sackett, et al. Benefit of Carotid Endarterectomy in Patients with Symptomatic Moderate or Severe Stenosis N. Engl. J. Med., November 12, 1998; 339(20): 1415 - 1425. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. V. Tu, E. L. Hannan, G. M. Anderson, K. Iron, K. Wu, K. Vranizan, A. J. Popp, and K. Grumbach The Fall and Rise of Carotid Endarterectomy in the United States and Canada N. Engl. J. Med., November 12, 1998; 339(20): 1441 - 1447. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C J M Whitty, C L M Sudlow, and C P Warlow Investigating individual subjects and screening populations for asymptomatic carotid stenosis can be harmful J. Neurol. Neurosurg. Psychiatry, May 1, 1998; 64(5): 619 - 623. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. D. Cebul, R. J. Snow, R. Pine, N. R. Hertzer, and D. G. Norris Indications, Outcomes, and Provider Volumes for Carotid Endarterectomy JAMA, April 22, 1998; 279(16): 1282 - 1287. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Broderick, T. Brott, R. Kothari, R. Miller, J. Khoury, A. Pancioli, J. Gebel, D. Mills, L. Minneci, and R. Shukla The Greater Cincinnati/Northern Kentucky Stroke Study : Preliminary First-Ever and Total Incidence Rates of Stroke Among Blacks Stroke, February 1, 1998; 29(2): 415 - 421. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. H. Wong, J. M. Findlay, and M. E. Suarez-Almazor Regional Performance of Carotid Endarterectomy : Appropriateness, Outcomes, and Risk Factors for Complications Stroke, May 1, 1997; 28(5): 891 - 898. [Abstract] [Full Text]
|
|
|
|
|
|
C. P. Derdeyn and W. J. Powers Cost-Effectiveness of Screening for Asymptomatic Carotid Atherosclerotic Disease Stroke, November 1, 1996; 27(11): 1944 - 1950. [Abstract] [Full Text]
|
|
|
|
|
|
P.M. Rothwell, J. Slattery, and C.P. Warlow A Systematic Review of the Risks of Stroke and Death Due to Endarterectomy for Symptomatic Carotid Stenosis Stroke, February 1, 1996; 27(2): 260 - 265. [Abstract] [Full Text]
|
|
|
|
|
|
P.M. Rothwell, J. Slattery, and C.P. Warlow A Systematic Comparison of the Risks of Stroke and Death Due to Carotid Endarterectomy for Symptomatic and Asymptomatic Stenosis Stroke, February 1, 1996; 27(2): 266 - 269. [Abstract] [Full Text]
|
|
|
|
 |
|
 W. H. Baker Carotid Endarterectomy: The Importance of Technical Perfection Vascular and Endovascular Surgery, November 1, 1995; 29(6): 441 - 442. [PDF]
|
|
|
|
|
|
S. J. Patrick, J. Concato, C. Viscoli, D. Chyatte, and L. M. Brass Sex Differences in the Management of Patients Hospitalized With Ischemic Cerebrovascular Disease Stroke, April 1, 1995; 26(4): 577 - 580. [Abstract] [Full Text]
|
|
|
|
 |
|
 W. S. Moore, H.J.M. Barnett, H. G. Beebe, E. F. Bernstein, B. J. Brener, T. Brott, L. R. Caplan, A. Day, J. Goldstone, R. W. Hobson II, et al. Guidelines for Carotid Endarterectomy : A Multidisciplinary Consensus Statement From the Ad Hoc Committee, American Heart Association Circulation, January 15, 1995; 91(2): 566 - 579. [Abstract] [Full Text]
|
|
|
|
 |
|
 A. Kazmers Outcome After Surgery: An Evolving Concept Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1995; 8(1): 109 - 128. [PDF]
|
|
|
|
|
|
W. S. Moore, H.J.M. Barnett, H. G. Beebe, E. F. Bernstein, B. J. Brener, T. Brott, L. R. Caplan, A. Day, J. Goldstone, R. W. Hobson II, et al. Guidelines for Carotid Endarterectomy : A Multidisciplinary Consensus Statement From the Ad Hoc Committee, American Heart Association Stroke, January 1, 1995; 26(1): 188 - 201. [Abstract] [Full Text]
|
|
|
|
|
|
D. Bergqvist Risk-Benefit Aspects of Surgery for Symptomatic Carotid Artery Stenosis Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1994; 7(2): 1 - 5. [PDF]
|
|
|
|
|
|
R. W. Hobson, D. G. Weiss, W. S. Fields, J. Goldstone, W. S. Moore, J. B. Towne, C. B. Wright, and Veterans Affairs Cooperative Study Group Efficacy of Carotid Endarterectomy for Asymptomatic Carotid Stenosis N. Engl. J. Med., January 28, 1993; 328(4): 221 - 227. [Abstract] [Full Text]
|
|
|
|
|
|
A. Kashyap and N. Deshmukh Carotid Endarterectomy in the Elderly Patient: Experience Over the Past 15 Years Vascular and Endovascular Surgery, September 1, 1992; 26(7): 552 - 557. [Abstract] [PDF]
|
|
|
|
|
|
A. Mingoli, R. T. Bailey JR., D. H. Kretchmar, J. A. Hagen, R. Santoscoy, W. J. Hunter, N. Gupta, R. C. Koe, and J. T. Sugimoto Effect of Low-Dose Aspirin on Platelet Adherence After Carotid Endarterectomy in Dogs Vascular and Endovascular Surgery, September 1, 1991; 25(7): 530 - 540. [Abstract] [PDF]
|
|
|
|
|
|
J. R. Rubin and L. M. Graham Carotid Surgery in the Community Hospital Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1990; 3(2): 30 - 41. [PDF]
|
|
|
|
|
|
R. W. Hobson Asymptomatic Carotid Stenosis: Current Diagnosis and Management Perspectives in Vascular Surgery and Endovascular Therapy, January 1, 1988; 1(1): 141 - 154. [PDF]
|
|
|
|
 |
|
 D. B. Matchar and S. G. Pauker Transient Ischemic Attach in a Man with Coronary Artery Disease: Two Strategies Neck and Neck Med Decis Making, December 1, 1986; 6(4): 239 - 249. [PDF]
|
|