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Objectives:Following publication of the CREST data in 2010, we performed a retrospective case review study to compare our results with carotid endarterectomy (CEA) to the published CREST standards. Our results are those of a single surgeon in a community hospital.
Methods: Charts of 412 patients who underwent 451 endarterectomies from January 2005 though December 2010 were reviewed. Thirty eight patients underwent bilateral endarterectomies while one patient required a redo procedure at greater than ninety days for recurrent stenosis. Asymptomatic patients were chosen for surgery on the basis of a greater than 80% stenosis by carotid duplex. Symptomatic patients with a greater than a 50% stenosis by duplex, MRA or CTA were selected for surgery. All operations were performed under cervical block anesthesia. Symptomatic patients comprised 31.9% of the group. There were 242 males and 170 females. Smokers comprised 37.3% of the population, 82.9% were hypertensive, 31.3% were diabetic, 21.3 % had known coronary artery disease. 5.3% had congestive heart failure. Anti-platelet agents were used by 71.4% at presentation; all were on at least aspirin at the time of surgery.Statins were used by 56.3% while beta blockers were used by 60.3%.
Results: There were no perioperative strokes; however there were two deaths. The combined periprocedural endpoint of stroke, MI and death was 0.44%, substantially lower than the 4.5% reported for the CEA arm of CREST or the 5.2% in the stenting arm.
Conclusions: In our practice, CEA is an effective treatment for symptomatic and asymptomatic carotid stenosis.