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(Stroke. 1999;30:1745-1750.)
© 1999 American Heart Association, Inc.

Editorial

Carotid Endarterectomy

Where Do We Draw the Line?

Philip B. Gorelick, MD, MPH

From the Department of Neurologic Sciences, Rush Medical College, Chicago, Ill.

Correspondence to Philip B. Gorelick, MD, MPH, Center for Stroke Research, 1645 West Jackson, Suite 400, Chicago, IL 60612.

Key Words: carotid endarterectomy • complications • editorials • stroke

	Introduction

 
In March 1951, Fisher's report on occlusion of the internal carotid artery characterized basic clinical and pathological features of an important disease syndrome.¹ Fisher described fleeting neurological symptoms attributable to atherosclerotic narrowing, thrombosis, and cerebral embolism that might arise from thrombotic material lying in the carotid sinus. He suggested that vascular surgical bypass of the occluded portion of the artery by anastomosis of the external carotid artery or one of its branches with the internal carotid artery above the area of narrowing might be feasible. In October 1951, Carrea et al^{2 3} of Buenos Aires, Argentina, who were aware of Fisher's work,¹ performed the first successful carotid reconstruction. This included partial ablation of the atherosclerotic plaque and end-to-end anastomosis of the proximal portion of the external carotid to the distal portion of the internal carotid. In May 1954, Eascott et al⁴ performed resection and reconstruction of the common and internal carotid arteries by direct end-to-end anastomosis, an operation that gave impetus to the development of extracranial carotid surgery.³ However, in 1953, DeBakey⁵ was credited with performing the first successful carotid endarterectomy (CEA), the procedure that has dominated surgery for extracranial carotid occlusive disease for the past 4 to 5 decades.³

These pioneers^{1 2 3 4 5} helped to usher in the modern era of CEA. Early attempts at surgical correction of extracranial carotid artery occlusive disease led to the Joint Study of Extracranial Arterial Occlusion in 1959.⁶ The Joint Study was designed to assess the efficacy of carotid surgery and included 6535 patients (69% men). . . . [Full Text of this Article]

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