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Carotid Endarterectomy: Surgical Techniques, Emboli, and Outcomes

Department of Surgery, Leicester Royal Infirmary, Leicester, United Kingdom

Carotid endarterectomy (CEA) is now the single most commonly performed peripheral vascular procedure in the western world, and is one of the few surgical procedures to be evaluated in level 1 randomized trials. Yet, despite that it has a proven role in selected patients it still remains a source of continuing debate. At pres ent, there is little consensus on many of the individual aspects of the procedure, such as the role of patching, shunting, and general anesthesia. More recently, there has been an increasing interest in the role of periopera tive monitoring, largely because of increasing aware ness that most strokes follow inadvertent surgeon error. This article reviews the surgical aspects of CEA together with an overview of the evolution of a monitor ing program, which has contributed to a 60% reduction in operative risk.

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