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(Stroke. 2000;31:1799.)
© 2000 American Heart Association, Inc.

Editorial

Cerebrovascular Monitoring During Carotid Endarterectomy

Viken L. Babikian, MD Nancy L. Cantelmo, MD

From the Departments of Neurology (V.L.B.) and Surgery (N.L.C.), Boston University School of Medicine, Boston, Mass.

Correspondence to Viken Babikian, MD, Department of Neurology, Boston University School of Medicine, Boston VA Medical Center, 150 South Huntington Ave, Boston, MA 02130.

Key Words: carotid endarterectomy • complications • editorials

Carotid endarterectomy (CEA) is recognized today as the treatment of choice for selected patients with symptomatic or asymptomatic, severe, extracranial internal carotid artery stenosis. Introduced in the 1950s and perfected during the subsequent years, the number of CEAs has increased since the early 1990s¹ to an annual rate exceeding 130 000 cases.² CEA is the most frequently performed noncardiac vascular procedure in the United States.²

Stroke, myocardial infarction, and death are the major complications of CEA, myocardial infarction being a frequent cause of death.³ In 1995, an Ad Hoc Committee for the American Heart Association published guidelines which indicated that for the procedure to be efficacious, a surgeon’s combined morbidity and mortality rate should be <6% for symptomatic patients and <3% for those who are asymptomatic.⁴ Large CEA trials have shown that these figures can be achieved at selected centers.^{5 6} There is an increasing concern, however, that these rates may be exceeded in wider practice.⁷ In a recently published prospective study at a single medical center,⁸ a combined stroke and death rate of 8.3% was reported, and the rate was 11.1% when symptomatic patients were analyzed as a separate group. In addition, although the mortality rate for Medicare beneficiaries decreased from 1985 to 1996, it did not attain the rates of the trials,⁹ and it was 2.5% at hospitals with a low volume that did not participate in the CEA trials.⁷ More than likely, rates vary among surgeons and hospitals.^{7 10 11}

Stroke is the most common major complication of CEA. Its . . . [Full Text of this Article]

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