(Stroke. 1997;28:889-890.)
© 1997 American Heart Association, Inc.
Articles |
Complication Rates for Carotid Endarterectomy
A Call to Action
From the Durham Department of Veterans Affairs Medical Center, the Center for Health Policy Research and Education, and the Division of Neurology, Duke University, Durham, NC (L.B.G.); the Section of Vascular Surgery, University of California at Los Angeles School of Medicine (W.S.M.); the Department of Neurosurgery, University of Tennessee Medical Center (Memphis) (J.T.R.); and the Department of Neurology, Wayne State University, Detroit, Mich (S.C.).
Correspondence to Larry B. Goldstein, MD, Box 3651, Duke University Medical Center, Durham, NC 27710. E-mail golds004@mc.duke.edu
Key Words: carotid endarterectomy • complications
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Introduction |
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The efficacy of carotid endarterectomy (CEA) for selected patients with high-grade stenosis of the extracranial carotid artery has now been established through a series of randomized, controlled trials.1 2 3 4 5 6 The reduction in stroke risk afforded by this prophylactic procedure is highly dependent on perioperative complication rates.7 Combined stroke and death rates much exceeding 3% for patients with asymptomatic stenosis and 6% for patients with symptomatic stenosis would eliminate the benefit in stroke reduction gained through the operation.8
A systematic review of the risks of stroke and death due to CEA based
on 25 studies published since 1980 estimated 30-day complication rates
of 3.35% for asymptomatic stenosis and 5.18% for
symptomatic stenosis (including mortality rates of
1.3% and 1.8%, respectively).9 This review included
studies based on a variety of methodologies. A companion review based
on 51 studies of complication rates for patients undergoing CEA for
symptomatic carotid stenosis found that the risk of
surgery varied systematically with the methods and authorship of the
report.10 The risk of stroke and/or death was highest in
studies in which the patient was assessed by a neurologist after
surgery (7.7%) and lowest in studies with a single author affiliated
with a surgery department (2.3%). On the basis of data from the
National Hospital Discharge Survey reflecting the years 1971 through
1982, it was estimated that the perioperative mortality
rate for CEA in the United States was 2.8%,11 with
combined stroke and death rates estimated to be between 5.6% and
16.8%.12 Although the 30-day death rate after
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