Published Online
on November 13, 2003

A more recent version of this article appeared on December 1, 2003

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Submitted on July 1, 2003
Accepted on July 23, 2003

Durability of Carotid Endarterectomy

Robert D. Ecker MD; Mark A. Pichelmann MD; Irene Meissner MD; and Fredric B. Meyer MD^*

From the Departments of Neurosurgery (R.D.E., M.A.P., F.B.M.) and Neurology (I.M.), Mayo Clinic and Foundation, Rochester, Minn.

^* To whom correspondence should be addressed. E-mail: meyer.fredric{at}mayo.edu.

Background and Purpose--We sought to determine the incidence of recurrent stenosis after carotid endarterectomy.

Methods--One thousand consecutive carotid endarterectomy patients were followed prospectively. The surgery was performed in a standard fashion. Cerebral protection was provided with intraoperative electroencephalographic monitoring and selective shunting. All arteriotomies were repaired with a patch graft. Each patient was seen 3 months after surgery and then yearly, with a duplex ultrasound obtained at each visit. Evidence for new ischemic events or recurrent stenosis of 70% was recorded.

Results--The 30-day combined minor and major stroke and death rate was 1.9%. At 7.1-year follow-up, 0.1% of patients had recurrent stenosis 70%, the majority of which were asymptomatic.

Conclusions--Carotid endarterectomy is a low-risk procedure for the treatment of carotid occlusive disease, with excellent long-term durability. Although less invasive, carotid angioplasty must demonstrate equal robustness in long-term follow-up before it is considered a routine alternative to surgery.

Key words: carotid endarterectomy • stenosis • stroke

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