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Carotid Endarterectomy: A Review

Published online by Cambridge University Press:  02 December 2014

J. Max Findlay ,
B. Elaine Marchak ,
David M. Pelz  and
Thomas E. Feasby
J. Max Findlay
Affiliation:
Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta
B. Elaine Marchak
Affiliation:
Department of Anaesthesia, University of Alberta, Edmonton, Alberta
David M. Pelz
Affiliation:
Department of Diagnostic Radiology, University of Western Ontario, London, Ontario, Canada
Thomas E. Feasby
Affiliation:
Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta
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Abstract

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Background:

Since the validation of carotid endarterectomy (CEA) as an effective means of stroke prevention, there has been renewed interest in its best indications and methods, as well as in how it compares to carotid angioplasty and stenting (CAS). This review examines these topics, as well as the investigation of carotid stenosis and the role of auditing and reporting CEAresults.

Investigation:

Brain imaging with CTor MRI should be obtained in patients considered for CEA, in order to document infarction and rule out mass lesions. Carotid investigation begins with ultrasound and, if results agree with subsequent, good-quality MRAor CTangiography, treatment can be planned and catheter angiography avoided. An equally acceptable approach is to proceed directly from ultrasound to catheter angiography, which is still the gold-standard in carotid artery assessment.

Indications:

Appropriate patients for CEA are those symptomatic with transient ischemic attacks or nondisabling stroke due to 70-99% carotid stenosis; the maximum allowable stroke and death rate being 6%. Uncertain candidates for CEA are those with 50 - 69% symptomatic stenosis, and those with asymptomatic stenosis ≥ 60% but, if selected carefully on the basis of additional risk factors (related to both the carotid plaque and certain patient characteristics), some will benefit from surgery. Asymptomatic patients will only benefit if surgery can be provided with exceptionally low major complication rates (3% or less). Inappropriate patients are those with less than 50% symptomatic or 60% asymptomatic stenosis, and those with unstable medical or neurological conditions.

Techniques:

Carotid endarterectomy can be performed with either regional or general anaesthesia and, for the latter, there are a number of monitoring techniques available to assess cerebral perfusion during carotid cross-clamping. While monitoring cannot be considered mandatory and no single monitoring technique has emerged as being clearly superior, EEG is most commonly used. “Eversion” endarterectomy is a variation in surgical technique, and there is some evidence that more widely practiced patch closure may reduce the acute risk of operative stroke and the longer-term risk of recurrent stenosis.

Carotid angioplasty and stenting:

Experience with this endovascular and less invasive procedure grows, and its technology continues to evolve. Some experienced therapists have reported excellent results in case series and a number of randomized trials are now underway comparing CAS to CEA. However, at this time it is premature to incorporate CAS into routine practice replacing CEA.

Auditing:

It has been shown that auditing of CEA indications and results with regular feed-back to the operating surgeons can significantly improve the performance of this operation. Carotid endarterectomy auditing is recommended on both local and regional levels.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 31 , Issue 1 , February 2004 , pp. 22 - 36
Copyright
Copyright © The Canadian Journal of Neurological 2004

References

1.Winslow, CM, Solomon, DH, Chassin, MR, et al. Theappropriateness of carotid endarterectomy. N Engl J Med 1988;318:721–727.Google Scholar
2.Barnett, HJ, Plum, F, Walton, JN.Carotid endarterectomy: anexpression of concern. Stroke 1984;15:941–943.Google Scholar
3.Warlow, C.Carotidendarterectomy: does it work? Stroke 1984;15:1068–1076.CrossRefGoogle Scholar
4.Huber, TS, Durance, PW, Kazmers, A, Jacobs, LA.Effect of theAsymptomatic Carotid Atherosclerosis Study on carotid endarterectomy in Veterans Affairs Medical Centers. Arch Surg 1977;132:1134–1139.Google Scholar
5.Hsia, DC, Moscoe, LM, Krushat, WM.Epidemiology of carotidendarterectomy among medicare beneficiaries 1985-1996 update. Stroke 1998;29:346–350.Google Scholar
6.Tu, JV, Hannan, EL, Anderson, GM, et al. The fall and rise of carotidendarterectomy in the United States and Canada. N Engl J Med 1998;339:1441–1447.Google Scholar
7.Morasch, MD.Carotid endarterectomy: characterization of recentincreases in procedure rates. J Vasc Surg 2000;31:901–909.Google Scholar
8.Kresowik, TF, Braztler, D, Karp, HR, et al. Multistate utilization,processes, and outcomes of carotid endarterectomy. J Vasc Surg 2001;33:227–235.Google Scholar
9.Feasby, TE, Quan, H, Ghali, WA.Geographic variation in the rate ofcarotid endarterectomy in Canada. Stroke 2001;32:2417–2422.Google Scholar
10.Culebras, A, Kase, CS, Masdeu, JC, et al. Practice guidelines for theuse of imaging in transient ischemic attacks and acute stroke. A report of the stroke council, American Heart Association. Stroke 1997;28:1480–1497.Google Scholar
11.Hankey, GJ, Warlow, CP, Molyneus, AJ.Complications of cerebralangiography for patients with mild carotid territory ischaemia being considered for carotid endarterectomy. J Neurol Neurosurg Psychiatry 1990;53:542–548.CrossRefGoogle Scholar
12.Eliasziw, M, Rankin, RN, Fox, AJ, Haynes, RB, Barnett, HJ for the North American Symptomatic Carotid Endarterectomy Trial (NASCET Group). Accuracy and prognostic consequences of ultrasonography in identifying severe carotid artery stenosis. Stroke 1995;26:1747–1752.Google Scholar
13.Qureshi, AI, Suri, FK, Ali, Z, et al. Role of conventional angiography in evaluation of patients with carotid artery stenosis demonstrated by Doppler ultrasound in general practice. Stroke 2001;32:2287–2291.Google Scholar
14.Anderson, GB, Ashforth, R, Steinke, DE, Ferdinandy, R, Findlay, JM.CT angiography for the detection of characterization of carotid bifurcation disease. Stroke 2000;31:2168–2174.Google Scholar
15.Wardlaw, JM, Lewis, SC, Humphrey, P, et al. How does the degree ofcarotid stenosis affect the accuracy and interobserver variability of magnetic resonance angiography? J Neurol Neurosurg Psychiatry 2001;71:155–160.Google Scholar
16.Ozaki, CK, Irwin, PB, Flynn, TCHuber, TS, Seeger, JM.Surgicaldecision making for carotid endarterectomy and contemporary magnetic resonance angiography. Am J Surg 1999;178:182–184.Google Scholar
17.Johnston, DCC, Goldstein, LB.Clinical carotid endarterectomydecision making. Noninvasive vascular imaging versus angiography. Neurology 2001;56:1009–1015.Google Scholar
18.Larkin, M.Should endarterectomy decisions be based on non-invasive imaging? Lancet 2001;357:1343.Google Scholar
19.Rothwell, PM, Pendlebury, ST, Wardlaw, J, Warlow, CP.Criticalappraisal of the design and reporting of studies imaging and measurement of carotid stenosis. Stroke 2000;31:1444–1450.CrossRefGoogle Scholar
20.Nederkoorn, PJ, Mali, WP, Eikelboom, BC, et al. Preoperativediagnosis of carotid artery stenosis. Accuracy of noninvasivetesting. Stroke 2002;33:2003–2008.Google Scholar
21.Chaturvedi, S, Policherla, PN, Femino, L.Cerebral angiographypractices at US teaching hospitals. Implications for carotid endarterectomy. Stroke 1997;28:1895–1897.Google Scholar
22.Ruehm, SG, Goyen, M, Barkhausen, J, et al. Rapid magneticresonance angiography for detection of atherosclerosis. Lancet 2001;357:1086–1091.Google Scholar
23.Phan, T, Huston, J, Bernstein, MA, Riederer, SJ, Brown, RD Jr.Contrast-enhanced magnetic resonance angiography of the cervical vessels. Experience with 422 patients. Stroke 2001;32:2282–2286.Google Scholar
24.Wutke, R, Lang, W, Fellner, C, et al. High-resolution, contrast-enhanced magnetic resonance angiography with elliptical centric k-space ordering of supra-aortic arteries compared with selective x-ray angiography. Stroke 2002;33:1522–1529.CrossRefGoogle ScholarPubMed
25.Fox, AJ.How to measure carotid stenosis. Radiology 1993;186:316–318.Google Scholar
26.North American Symptomatic Carotid Endarterectomy TrialCollaborators. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med 1991;325:445–453.Google Scholar
27.Barnett, HJM, Taylor, DW, Eliaziw, M, et al, for the North AmericanSymptomatic Carotid Endarterectomy Trial Collaborators. Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis. N Engl J Med 1998;339:1415–1425.Google Scholar
28.European Carotid Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. Lancet 1991;337:1235–1243.Google Scholar
29.European Carotid Surgery Trial. Endarterectomy for moderatesymptomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial. Lancet 1996;347:1591–1593.CrossRefGoogle Scholar
30.Mayberg, MR, Wilson, SE, Yatsu, F, et al, for the Veterans AffairsCooperative Studies Program 309 Trialist Group. Carotid endarterectomyand preventionof cerebralischemia insymptomatic carotid stenosis. JAMA 1993;266:3289–3294.Google Scholar
31.Hobson, RW, Weiss, DG, Fields, WS, et al, for the Veterans AffairsCooperative Study Group. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis. N Engl J Med 1993;328:221–227.Google Scholar
32.Executive Committee for the Asymptomatic Carotid Atherosclerosis Study. Endarterectomy for asymptomatic carotid artery stenosis. JAMA 1995;273:1421–1428.CrossRefGoogle Scholar
33.Rothwell, PM, Eliasziw, M, Gutnikow, A, et al; CarotidEndarterectomy Trialists’ Collaboration. Analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003;361:107–116.Google Scholar
34.Barnett, HJM, Meldrum, HE, Eliasziw, M, for the North AmericanSymptomatic Carotid Endarterectomy Trial (NASCET) Collaborators. The appropriate use of carotid endarterectomy. CMAJ 2002;166(9):1169–1179.Google Scholar
35.Kistler, JP, Furie, KL.Carotid endarterectomy revisited. N Engl JMed 2000;342:1693–1700.Google Scholar
36.Biller, J, Feinberg, WM, Castaldo, JE, et al. Guidelines for carotidendarterectomy: a statement for healthcare professionals from a special writing group of the Stroke Council, American HeartAssociation. Stroke 1998;29:554–562.Google Scholar
37.Gorelick, PB, Sacco, RL, Smith, DB, et al. Prevention of a firststroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA 1999;281:1112–1120.Google Scholar
38.Sacco, RL.Clinical Practice. Extracranial carotid stenosis. New Engl J Med 2001;345(15):1113–1118.Google Scholar
39.Perry, JR, Szalai, JP, Norris, JW, for the Canadian StrokeConsortium. Consensus against both endarterectomy and routine screening for asymptomatic carotid stenosis. Arch Neurol 1997;54:25–28.CrossRefGoogle Scholar
40.Barnett, HJ, Meldrum, ME.Carotid endarterectomy: a neuro-therapeutic advance. Arch Neurol 2000;57:40–45.CrossRefGoogle Scholar
41.Moore, WS, Barnett, JHM, Beebe, HG, et al. Guidelines for carotidendarterectomy: a multidisciplinary consensus statement from the Ad Hoc Committee, American Heart Association. Stroke 1995;26:188–201.CrossRefGoogle Scholar
42.Findlay, JM, Tucker, WS, Ferguson, GG, et al. Guidelines for the useof carotid endarterectomy: current recommendations from the Canadian Neurosurgical Society. Can Med Assoc J 1997;157(6):653–659.Google Scholar
43.Wolf, PA, Clagett, GP, Easton, JD, et al. Preventing ischemic strokein patients with prior stroke and transient ischemic attack: a statement from healthcare professionals from the Stroke Council of the American Heart Association. Stroke 1999;30:1991–1994.Google Scholar
44.Albers, GW, Hart, RG, Lutsep, HL, Newell, DW, Sacco, RL.Supplement to the guidelines for the management of transient ischemic attacks: a statement from the Ad Hoc Committee on Guidelines for the Management of Transient Ischemic Attacks, Stroke Council, American Heart Association. Stroke 1999;30:2502–2511.Google Scholar
45.Benavente, O, Eliasziw, M, Streifler, JY, et al; North AmericanSymptomatic Carotid Endarterectomy Trial Collaborators. Prognosis after transient monocular blindness associated with carotid artery stenosis. N Engl J Med 2001;345(15):1084–1090.Google Scholar
46.Morgenstern, LB, Fox, AJ, Sharpe, BL, et al. The risks and benefitsof carotid endarterectomy in patients with near occlusion of the carotid artery. Neurology 1997;48:911–915.Google Scholar
47.Rothwell, PM, Gibson, R, Warlow, CP, on behalf of the EuropeanCarotid Trialists’ Collaborative Group. Interrelation between plaque surface morphology and degree of stenosis on carotid angiograms and the risk of ischemic stroke in patients with symptomatic carotid stenosis. Stroke 2000;31:615–621.Google Scholar
48.Eliasziw, M, Streifler, JY, Fox, AJ, et al. Significance of plaqueulceration in symptomatic patients with high-grade carotid stenosis. Stroke 1994;25:304–308.Google Scholar
49.Gasecki, AP, Eliasziw, M, Ferguson, GG, Hachinski, V, Barnett, HJ.Long-term prognosis and effect of endarterectomy in patients with symptomatic severe carotid stenosis and contralateral carotid stenosis or occlusion: results from NASCET. J Neurosurg 1995;83:778–782.Google Scholar
50.Villarreal, J, Silva, J, Eliasziw, M, et al for the North AmericanSymptomatic Carotid Endarterectomy Trial (NASCET) Group. Prognosis of patients with an intraluminal thrombus in the internal carotid artery. Stroke 1998;29:276.Google Scholar
51.Kappelle, LJ, Eliasziw, M, Fox, AJ, Sharpe, BL, Barnett, HJ.Importance of intracranial atherosclerotic disease in patients with symptomatic stenosis of the internal carotid artery. Stroke 1999;30:282–286.Google Scholar
52.Henderson, RD, Eliasziw, M, Fox, AJ, Rothwell, PM, Barnett, HJ.Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. Stroke 2000;31:128–132.CrossRefGoogle ScholarPubMed
53.Streifler, JY, Eliasziw, M, Benavente, OR, et al, North AmericanSymptomatic Carotid Endarterectomy Trial Group. Prognostic importance of leukoaraiosis in patients with symptomatic internal carotid artery stenosis. Stroke 2003;33:1651–1655. Google Scholar
54.The European Carotid Surgery Trialists Collaborative Group. Riskof stroke in the distribution of an asymptomatic carotid artery. Lancet 1995;345:209–212.Google Scholar
55.Inzitari, D, Eliasziw, M, Gates, P, et al. The causes and risk of strokein patients with asymptomatic internal-carotid artery stenosis. N Engl J Med 2000;342:1693–1700.CrossRefGoogle Scholar
56.Hougaku, H, Matsumoto, M, Handa, N, et al. Asymptomatic carotidlesions and silent cerebral infarction. Stroke 1994;25:566–570.Google Scholar
57.Norris, JW, Zhu, CZ, Bornstein, NM, Chambers, BR.Vascular risksof asymptomatic carotid stenosis. Stroke 1992;22:1485–1490.CrossRefGoogle Scholar
58.Moore, WS, Boren, C, Malone, JM, et al. Natural history ofnonstenotic, asymptomatic ulcerative lesions of the carotid artery. Arch Surg 1978;113:1352–1359.CrossRefGoogle ScholarPubMed
59.Dixon, S, Pais, SO, Raivola, C, et al. Natural history of nonstenotic,asymptomatic ulcerative lesions of the carotid artery: a further analysis. Arch Surg 1982;117:1493–1498.Google Scholar
60.Autret, A, Pourcelot, L, Saudea, D, et al. Stroke risk in patients withcarotid stenosis. Lancet 1987;1:888–890.Google Scholar
61.Weschler, LR.Ulceration and carotid artery disease. Stroke 1988;19:650–653.Google Scholar
62.Rutgers, DR, Klijn, CJM, Kappelle, LJ, et al. Sustained bilateralhemodynamic benefit of contralateral carotid endarterectomy in patients with symptomatic internal carotid artery occlusion. Stroke 2001;32:728–734.Google Scholar
63.Liapis, CD, Kakisis, JD, Kostakis, AG.Carotid stenosis. Factorsaffecting symptomatology. Stroke 2001;32:2782–2786.Google Scholar
64.Golledge, J, Greenhalgh, RM, Davies, AH.The symptomatic carotidplaque. Stroke 2000;31:774–781.CrossRefGoogle Scholar
65.Bock, RW, Grey-Weale, AC, Mock, PA, et al. The natural history ofasymptomatic carotid artery disease. J Vasc Surg 1993;17:160–171.Google Scholar
66.Reilly, LM, Lusby, RJ, Hughes, L, et al. Carotid plaque histologyusingreal-time ultrasonography. Clinical and therapeuticimplications. Am J Surg 1983;146:188–193.Google Scholar
67.AbuRahma, AF, Wulu, JT, Crotty, B.Carotid plaque ultrasonicheterogeneity and severity of stenosis. Stroke 2002;33:1772–1775.Google Scholar
68.Molloy, J, Markus, HS.Asymptomatic embolization predicts strokeand TIA risk for patients with carotid artery stenosis. Stroke 1999;30(7):1440–1443.CrossRefGoogle Scholar
69.Kallikazaros, I, Tsioufis, C, Sideris, S, Stefanadis, C, Toutouzas, P.Carotid artery disease as a marker for the presence of severe coronary artery disease in patients evaluated for chest pain. Stroke 1999;30:1002–1007.CrossRefGoogle ScholarPubMed
70.Gerraty, RP, Gates, PC, Doyle, JC.Carotid stenosis and perioperativestroke risk in symptomatic and asymptomatic patients undergoing vascular or coronary surgery. Stroke 1993;24:1115–1118.Google Scholar
71.Ricotta, JJ, Faggioli, GL, Castilone, A, Hassett, JM.Risk factors forstroke after cardiac surgery: Buffalo Cardiac-Cerebral Study Group. J Vasc Surg 1995; 21:359–363.Google Scholar
72.Palerme, LP, Hill, AB, Obrand, D, Steinmetz, OK.Is Canadiancardiac surgeons’ management of asymptomatic carotid artery stenosis at coronary artery bypass supported by the literature? A survey and a critical appraisal of the literature. Can J Surg 2000;43:93–103.Google Scholar
73.Das, SK, Brow, TD, Pepper, J.Continuing controversy in themanagement of concomitant coronary and carotid disease: anoverview. Int J Cardiol 2000;74:47–65.Google Scholar
74.Takach, TJ, Reul, GJ Jr, Cooley, DA, et al. Is an integrated approachwarranted for concomitant carotid and coronary artery disease? Ann Thorac Surg 1997;64:16–22.Google Scholar
75.Darling, RC III, Dylewski, M, Chang, BB, et al. Combined carotidendarterectomy and coronary artery bypass grafting does not increase the risk of perioperative stroke Cardiovasc Surg 1998;6:448–452.Google Scholar
76.Minami, K, Fukahara, K, Boethig, D, et al. Long-term results ofsimultaneous carotid endarterectomy and myocardial revascularization with cardiopulmonary bypass used for both procedures. J Thorac Cardiovasc Surg 2000;19:764–773.Google Scholar
77.Estes, JM, Khabbaz, KR, Barnatan, M, Carpino, P, Mackey, WC.Outcome after combined carotid endarterectomy and coronary artery bypass is related to patient selection. J Vasc Surg 2001;33:1179–1184.Google Scholar
78.Landesberg, G, Wolf, Y, Schechter, D, et al. Preoperative thalliumscanning, selective coronary revascularization, and long-term survival after carotid endarterectomy. Stroke 1998;29:2541–2548.Google Scholar
79.Lopes, DK, Mericle, RA, Lanzino, G, et al. Stent placement for thetreatment of occlusive atherosclerotic carotid artery disease in patients with concomitant coronary artery disease. J Neurosurg 2002;96:490–496.Google Scholar
80.Little, JR, Moufarrij, NA, Furlan, AJ.Early carotid endarterectomyafter cerebral infarction. Neurosurgery 1989;24:334–338.Google Scholar
81.Gasecki, AP, Ferguson, GC, Eliasziw, M.Early endarterectomy forsevere carotid artery stenosis after a nondisabling stroke: results from the North American Symptomatic Carotid Endarterectomy Trial. J Vasc Surg 1994;2:288.Google Scholar
82.Hoffman, M, Robbs, J.Carotid endarterectomy after recent cerebralinfarction. Eur J Vasc Surg 1999;18(1):6–10.Google Scholar
83.Johnston, SC, Gress, DR, Browner, WS, Sidney, S.Short-termprognosis after emergency department diagnosis of TIA. JAMA 2000;284:2901–2906.Google Scholar
84.Blaser, T, Hofmann, K, Buerger, T, et al. Risk of stroke, transientischemic attack, and vessel occlusion before endarterectomy in patients with symptomatic severe carotid stenosis. Stroke 2002;33:1057–1062.CrossRefGoogle Scholar
85.Findlay, JM, Marchak, BE.Reoperation for acute hemisphericstroke after carotid endarterectomy:is there any value? Neurosurgery 2002;50(3):486–492.Google Scholar
86.Henderson, RD, Phan, TG, Piepgras, DG.Mechanisms ofintracerebral hemorrhageaftercarotid endarterectomy. JNeurosurg 2001;5(6):964–969.Google Scholar
87.Zannetti, S, Parente, B, De Rango, P, et al. Role of surgicaltechniques and operative findings in cranial and cervical nerve injuries during carotid endarterectomy. Eur J Vasc Endovasc Surg 1998;15(6):528–531.Google Scholar
88.Ferguson, GG, Eliasziw, M, Barr, HW, et al. The North AmericanSymptomatic Carotid Endarterectomy Trial: surgical results in 1415 patients. Stroke 1999;30(9):1751–1758.Google Scholar
89.Lanzino, G, Couture, D, Andreoli, A, Guterman, LR, Hopkins, LN.Carotid endarterectomy: can we select surgical candidates at high risk for stroke and low risk for perioperative complications? Neurosurgery 2001;49(4):913–924.Google Scholar
90.Sundt, TM Jr, Sandok, BA, Wisnant, JP.Carotid endarterectomy:complications and preoperative assessment of risk. Mayo ClinProc 1975;50:301–306.Google Scholar
91.Sieber, FE, Toung, TJ, Diringer, MN, Wang, H, Long, DM.Preoperative risks predict neurological outcome of carotid endarterectomy related stroke. Neurosurgery 1992;30(6):847–854.Google Scholar
92.McCrory, DC, Goldstein, LB, Samsa, GP, et al. Predictingcomplications of carotid endarterectomy. Stroke 1993;24(9):1285–1291.Google Scholar
93.Rothwell, PM, Slattery, J, Warlow, CP.Clinical and angiographicpredictors of stroke and death from carotid endarterectomy: systematic review. Br Med J 1997;315:1571–1577.Google Scholar
94.Goldstein, LB, Samsa, GP, Matchar, DB, Oddone, EZ.Multicenterreview of preoperative risk factors for endarterectomy for asymptomatic carotid artery stenosis. Stroke 1998;29(4):750–753.Google Scholar
95.Kucey, DS, Bowyer, B, Iron, K, et al. Determinants of outcome aftercarotid endarterectomy. J Vasc Surg 1998;28(6):1051–1058.Google Scholar
96.Bond, R, Narayan, SK, Rothwell, PM, Warlow, CP.European CarotidSurgery Trialists’ Collaborative Group. Clinical and radiographic risk factors for operative stroke death in the European Carotid Surgery Trial. Eur J Vasc Surg 2002; 23:108–116.Google Scholar
97.Rothwell, PM, Slattery, J, Warlow, CP.A systematic comparison ofthe risks of stroke and death due to carotid endarterectomy for symptomatic and asymptomatic stenosis. Stroke 1996;27(2):266–269.Google Scholar
98.Dardik, A, Bowman, HM, Gordon, TA, Hsieh, G, Perler, BA.Impactof race on the outcome of carotid endarterectomy: a population-based analysis of 9,842 recent elective procedures. Ann Sur 2000;232(5):704–709.Google Scholar
99.Meyer, FB, Piepgras, DG, Fode, NC.Surgical treatment of recurrentcarotid artery stenosis. J Neurosurg 1994;80(5):781–787. Google Scholar
100.AbuRahma, AF, Jennings, TG, Wulu, JT, Tarakji, L, Robinson, PA.Redo carotid endarterectomy versus primary carotid endarterectomy. Stroke 2001;32:2787–2792.Google Scholar
101.Hill, BB, Olcott, C IV, Dalman, RL, Harris, EJ Jr, Zarins, CK.Reoperation for carotid stenosis is as safe as primary carotid endarterectomy. J Vasc Surg 1999;30(1):26–35.Google Scholar
102.Johnson, CA, Tollefson, DFJ, Olsen, SB, Andersen, CA, McKee-Johnson, J.The natural history of early recurrent carotid artery stenosis. Am J Surg 1999;177:433–436.Google Scholar
103.O’Neill, L, Lanska, DJ, Hartz, A.Surgeon characteristics associatedwith mortality and morbidity following carotid endarterectomy. Neurology 2000;55:773–781.Google Scholar
104.Hannan, EL, Popp, AJ, Feustel, P, et al. Association of surgicalspecialty and processes of care with patient outcomes for carotid endarterectomy. Stroke 2001;32:2890–2897.Google Scholar
105.Feasby, TE.The appropriateness and effectiveness of strokeprevention. In: Hachinski, V, Norris, J. (Eds). Stroke Prevention. Oxford University Press, 2001: 295–312.Google Scholar
106.Segal, HE, Rummel, L, Wu, B.The utility of PRO data on surgicalvolume: the example of carotid endarterectomy. Qual Rev Bull 1993;19:152–157.Google Scholar
107.Spetzler, RF, Martin, N, Hadley, MN, et al. Microsurg icalendarterectomy under barbiturate protection: a prospective study. J Neurosurg 1986;65:63–73.Google Scholar
108.Findlay, JM, Lougheed, W.Microsurgical endarterectomy. Tech Neurosurg 1977;3:34–44.Google Scholar
109.Shah, DM, Darling, RC III, Chang, BB, Kreienberg, PB, Paty, PS.Carotid endarterectomy by eversion technique: its safety and durability. Ann Surg 1998;228:471–478.Google Scholar
110.Peiper, C, Nowack, J, Ktenidis, K, et al. Eversion endarterectomyversus open thromboendarterectomy and patch plasty for the treatment of internal carotid artery stenosis. Eur J Vasc Endovasc Surg 2000;20:317–318.Google Scholar
111.Green, RM, Greenberg, R, Illig, K, Shortell, C, Ouriel, K.Eversionendarterectomy of the carotid artery: technical considerations and recurrent stenoses. J Vasc Surg 2000;32:1052–1061.Google Scholar
112.Katras, T, Baltazar, U, Rush, DS, et al. Durability of eversion carotidendarterectomy: comparison with primary closure and carotid patch angioplasty. J Vasc Surg 2001;34:453–458.Google Scholar
113.Cao, P, Giordano, G, De Rango, P, et al. Eversion versusconventional carotid endarterectomy: late results of a prospective multicenter randomized trial. J Vasc Surg 2000;31:19–30.CrossRefGoogle ScholarPubMed
114.Cao, PG, de Rango, P, Zannetti, S, et al. Eversion versusconventional carotid endarterectomy for preventing stroke. Cochrane Database Syst Rev 1:CD001921, 2001.Google Scholar
115.Jackson, MR, Clagett, GP.Use of vein or synthetic patches in carotidendarterectomy. In: Loftus, CM, Kresowik, TK (Eds). Carotid Artery Surgery. New York: Thieme 1999:281–290.Google Scholar
116.Yamamoto, Y, Piepgras, DG, Marsh, WR, Meyer, FB.Complicationsresulting from saphenous vein patch graft after carotid endarterectomy. Neurosurgery 1996;39:670–675.Google Scholar
117.AbuRahma, AF, Robinson, PA, Saiedy, S, Richmond, BK, Khan, J.Prospective randomized trial of bilateral carotid endarterectomies. Primary closure versus patching. Stroke 1999;30:1185–1189.Google Scholar
118.AbuRahma, AF, Khan, JH, Robinson, PA, et al. Prospectiverandomized trial of carotid endarterectomy with primary closure and patch angioplasty with saphenous vein, jugular vein, and polytetrafluoroethylene: perioperative (30-day) results. J Vasc Surg 1996;24:998–1007.Google Scholar
119.Counsell, CE, Salinas, R, Naylor, R, Warlow, CP.Asystematic reviewof the ramdomised trials of carotid patch angioplasty in carotid endarterectomy. Eur J Vasc Endovasc Surg 1997;13:345–354.Google Scholar
120.Hayes, PD, Allroggen, H, Steel, S, et al. Randomized trial of veinversus Dacron patching during carotid endarterectomy: influence of patch type on postoperative embolization. J Vasc Surg 2001;3:994–1000.Google Scholar
121.O’Hara, PJ, Hertzer, NR, Mascha, EJ, et al. A prospective,randomized study of saphenous vein patching versus synthetic patching during carotid endarterectomy. J Vasc Surg 2002;35:324–332.Google Scholar
122.Hugenholtz, H, Elgie, RG.Carotid thromboendarterectomy: areappraisal. J Neurosurg 1980;53:776–783.CrossRefGoogle Scholar
123.Meyer, FB, Sundt, TM, Piepgras, DG, Sandok, BA, Forbes, G.Emergency carotid endarterectomy for patients with acute carotid occlusion andprofound neurological deficits. Ann Surg 1986;203:82–89.Google Scholar
124.McCormick, PW, Spetzler, RF, Bailes, JE, Zabramski, JM, Frey, JL.Thromboendarterectomy of the symptomatic occluded internal carotid artery. J Neurosurg 1992;76:752–758.Google Scholar
125.Kasper, GC, Wladis, AR, Lohr, JM, et al. Carotid thrombo-endarterectomy for recent total occlusion of the internal carotid artery. J Vasc Surg 2001;33:242–249.Google Scholar
126.Cote, R, Barnett, HJM, Taylor, DW.Internal carotid occlusion. Aprospective study. Stroke 1983;14:898.CrossRefGoogle Scholar
127.Lennard, N, Smith, JL, Gaunt, ME, et al. A policy of quality controlassessment helps to reduce the risk of intraoperative stroke during carotid endarterectomy. Eur J Vasc Surg 1999;17:234–240.Google Scholar
128.Zannetti, S, Cao, P, De Rango, P, et al. Intraoperative assessment oftechnical perfection in carotid endarterectomy: a prospective analysis of 1305 completion procedures. Collaborators of the EVEREST study group. Eversion versus standard carotid endarterectomy. Eur J Vasc Surg 1999;18:52–58.Google Scholar
129.Padayachee, TS, McGuinness, CL, Modareski, KB, Arnold, JA, Taylor, PR.Value of intraoperative duplex imaging during supervised carotid endarterectomy. Br J Surg 2001;88:389–392.Google Scholar
130.Panneton, JM, Berger, MW, Lewis, BD, et al. Intraoperative duplexultrasound during carotid endarterectomy. Vasc Surg 2001;35:1–9.Google Scholar
131.North American Symptomatic Carotid Endarterectomy Trial Collaborators. Surgical results in 1415 patients. Stroke 1999;30:1751–1758.Google Scholar
132.European Carotid Surgery Trial Collaborative Group. Variation insurgical and anesthetic technique and associations with operative risk in the European Carotid Surgery Trial: implications for trials of ancillary techniques. Eur J Vasc Endovasc Surg 2002;23:117–126.Google Scholar
133.Knighton, JD, Stoneham, MD.Carotid endarterectomy. A survey ofanaesthetic practice. Anaesthesia. 2000;55:475–488.Google Scholar
134.Cheng, MA, Theard, MA, Tempelhoff, R.Anesthesia for carotidendarterectomy: a survey. J Neurosurg Anesthesiol 1997;9:211–216.Google Scholar
135.Finocchi, C, Gandolfo, C, Tiziana, C, Del Sette, M, Bertoglio, C.Roleof transcranial Doppler and stump pressure during carotidendarterectomy. Stroke 1997;28:2448–2452.Google Scholar
136.Sundt, TM, Sharbrough, FW, Piepgras, DG, et al. Correlation ofcerebral blood flow and electroencephalographic changes during carotid endarterectomy. Mayo Clin Proc 1981;56:533–543.Google Scholar
137.Wellman, BJ, Loftus, CM, Kresowick, TF, Todd, M, Granner, MA.The differences in electroencephalographic changes in patients undergoing carotid endarterectomies while under local versus general anesthesia. Neurosurgy 1998;43:769–773.Google Scholar
138.Manninen, PH, Tan, TK, Sarjeant, RM.Somatosensory evokedpotential monitoring during carotid endarterectomy in patientswith a stroke. Anesth Analg 2001;93:39–44.Google Scholar
139.McCarthy, RJ, McCabe, AE, Walker, R, Horrocks, M.The value oftranscranial doppler in predicting cerebral ischemia during carotid endarterectomy. Eur J Vasc Endovasc Surg 2001;21:408–412.Google Scholar
140.Ackerstaff, RGA, Moons, KGM, van de Vlasakker, CJW, et al. Association of intraoperative transcranial doppler variables with stroke from carotid endarterectomy. Stroke 2000;31:1817–1823.Google Scholar
141.Dalman, JE, Beenakkers, ICM, Moll, FL, Leusink, JA, Ackerstaff, RGA.Transcranial doppler monitoring during carotid endarterectomy helps to identify patients at risk of postoperative hyperperfusion. Eur J Vasc Endovasc Surg 1999;18:222–227.Google Scholar
142.Beese, U, Langer, H, Lang, W, Dinkel, M.Comparison of nearinfrared spectroscopy and somatosensory evoked potentials for the detection of cerebral ischemia during carotid endarterectomy. Stroke 1998;2032–2037.Google Scholar
143.Samra, SK, Dy, EA, Welch, K, et al. Evaluation of a cerebraloximeter as a monitor of cerebral ischemia during carotid endarterectomy. Anesthesiology 2000;93:964–970.Google Scholar
144.Pandit, JJ, Bree, S, Dillon, P, et al. A comparison of superficial versuscombined (superficial and deep) cervical plexus block for carotid endarterectomy: a prospective, randomized study. Anesth Analg 2000;91:781–786.Google Scholar
145.Bourke, DL, Thomas, P.Mandibular nerve block in addition tocervical plexus block for carotid endarterectomy. Anesth Analg 1998;87:1034–1036.Google Scholar
146.Tangkanakul, C, Counsell, C, Warlow, C.Local versus generalanesthesia for carotid endarterectomy (Cochrane Review). In: The Cochrane Library, Issue 2, 2002.Google Scholar
147.Taylor, DW, Barnett, HJ, Haynes, RB, et al. Low-dose and high-doseacetylsalicylic acid for patients undergoing carotid endarterectomy: a randomised controlled trial: ASA and carotid endarterectomy (ACE) trial collaborators. Lancet 1999;353:2179–2184.Google Scholar
148.Rigdon, EE, Manajjem, N, Rhodes, RS.Criteria for selectiveutilization of the intensive care unit following carotid endarterectomy. Ann Vasc Surg 1997;11:220–237.Google Scholar
149.Harbaugh, KS, Harbaugh, RE.Early discharge after carotidendarterectomy. Neurosurgery 1995;37:219–225.Google Scholar
150.Radak, D, Popovic, AD, Radicevic, S, Neskovic, AN, Bojic, M.Immediate reoperation for perioperative stroke after 2250 carotid endarterectomies: differences between intraoperative and early postoperative stroke. J Vasc Surg 1999;30:245–251.Google Scholar
151.Rockman, CB, Castillo, J, Adelman, MA, et al. Carotidendarterectomy in female patients: are the concerns of the asymptomatic carotid atherosclerosis study valid? J Vasc Surg 2001;33:236–240.Google Scholar
152.Barr, JD, Horowitz, MB, Mathis, JM, Sclabassi, RJ, Yonas, H.Intraoperative urokinase infusion for embolic stroke during carotid endarterectomy. Neurosurgery 1995;36:606–611.Google Scholar
153.Winkelaar, GB, Salvian, AJ, Fry, PD, et al. Intraoperativeintraarterial urokinase in early postoperative stroke following carotid endarterectomy: a useful adjunct. Ann Vasc Surg 1999;13:566–570.Google Scholar
154.Perler, BA, Murphy, K, Sternbach, Y, Gailloud, P, Shake, JG.Immediate postoperative thrombolytic therapy: an aggressive strategy for neurologic salvage when cerebral thromboembolism complicates carotid endarterectomy. J Vasc Surg 2000;31:1033–1037.Google Scholar
155.Anzuini, A, Briguori, C, Roubin, GS, et al. Emergency stenting totreat neurological complicationsoccurring after carotidendarterectomy. J Am Coll Cardiol 2001;15:2074–2079.Google Scholar
156.Yadav, JS, Roubin, GS, Iyer, S, et al. Elective stenting of theextracranial carotid arteries. Circulation 1997;95:376–381.Google Scholar
157.Roubin, GS, New, G, Iyer, SS, et al. Immediate and late clinicaloutcomes of carotid artery stenting in patients with symptomatic and asymptomatic carotid artery stenosis. Circulation 2001;103:532–543.Google Scholar
158.Wholey, MH, Wholey, M, Mathias, K, et al. Global experience incervical artery stent placement. Catheter Cardiovasc Interv 2000;50:160–167.Google Scholar
159.Higashida, R.Treatment of carotid occlusive disease. An update onCREST and the carotid stenting trials. Proc. Sixth Joint Meeting of the AANS/CNS Section on Cerebrovascular Surgery and the American Society of Interventional and Therapeutic Neuroradiology. Phoenix, Feb 2003:21.Google Scholar
160.Iyer, SS, Roubin, GS, Vitek, JJ.Carotid stenting withneuroprotection. Circulation 2002;34:30a.Google Scholar
161.Whitlow, PL, Lylyk, P, Londero, H, et al. Carotid endarterectomystenting protected with an emboli containment system. Stroke 2002;33:1308–1314.Google Scholar
162.Al-Mubarak, N, Roubin, GS, Vitek, JJ, New, G, Iyer, SS.Proceduralsafety and short-term outcome of ambulatory carotid stenting. Stroke 2001;32:2305–2309.Google Scholar
163.Fox, DJ Jr, Moran, CJ, Cross, DT 3rd, et al. Long-term outcome afterangioplasty for symptomatic extracranial carotid stenosis in poorsurgical candidates. Stroke 2002;33:2877–2885.Google Scholar
164.Malek, AM, Higashida, RT, Phatouros, CC, et al. Stent angioplastyfor cervical carotid artery stenosis in high-risk symptomatic NASCET-ineligible patients. Stroke 2000;32:3029–3037.Google Scholar
165.Brott, TG.Angioplasty and stenting should only be performed in thesetting of a clinical trial. Stroke 2002;33:2519–2520.Google Scholar
166.Barnett, HJM.Carotid angioplasty/stenting versus endarterectomy. J Clin Neuroscience 2001;8:591–593.Google Scholar
167.Barth, A.Patient selection for carotid angioplasty and stenting. Stroke 2002;33:2347–2348.Google Scholar
168.Endovascular versus surgical treatment in patients with carotidstenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Lancet 2001;357:1729–1737.Google Scholar
169.Rothwell, PM, Eliasziw, M, Gutnikov, SA, et al; CarotidEndarterectomy Trialists’ Collaboration: analysis of pooled data from the randomized controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet 2003;361:107–116.Google Scholar
170.Kilaru, S, Korn, P, Kasirajan, K, et al. Is carotid angioplasty andstenting more cost effective than carotid endarterectomy? J Vasc Surg 2003;37:331–339.Google Scholar
171.Warren, JA, Jordan, WD, Heudebert, GR, Whitley, D, Wirthlin, DJ.Determining patient preference for treatment of extracranial carotid artery stenosis: carotid angioplasty and stenting versus endarterectomy. Ann Vasc Surg 2003;17:15–21.Google Scholar
172.Stoneburner, JM, Nishanian, GP, Cukingnan, RA, Carey, JS.Carotidendarterectomy using regional anaesthesia: a benchmark for stenting. Am Surg 2002;68:11201–1123.Google Scholar
173.Roubin, GS.Angioplasty and stenting should not be restricted toclinical trials. Stroke 2002;33:2520–2522.Google Scholar
174.Wholey, MH, Jarmolowski, CR, Wholey, M, Eles, GR.Carotid arterystent placement ’ ready for prime time? J Vasc Interv Radiol 2003;14:1–10.Google Scholar
175.Hobson, RW, Brott, TG, Ferguson, R, et al. CREST. Carotidrevascularization endarterectomy versus stent trial. Cardiovasc Surg 1997;5:457–458.Google Scholar
176.Wells, KB.Treatment research at the crossroads: the scientificinterface of clinical trials and effectiveness research. Am J Psychiat 1999;156:5–10.Google Scholar
177.Feasby, TE, Quan, H, Ghali, WA.Hospital and surgeon determinantsof carotid endarterectomy outcomes. Arch Neurol 2002;59:1877–1881.Google Scholar
178.Wong, J, Findlay, JM, Suarez-Almazor, M.Regional performance ofcarotid endarterectomy: appropriateness, outcomes and risk factors for complications. Stroke 1997;28:891–898.Google Scholar
179.Karp, HR, Flanders, WD, Shipp, CC, Taylor, B, Martin, D.Carotidendarterectomy among Medicare beneficiaries: a statewide evaluation of appropriateness and outcome. Stroke 1998;29:46–52.Google Scholar
180.Mayo, SW, Eldrup-Jorgensen, J, Lucas, FL, Wennberg, DE, Bredenberg, CE.Carotid endarterectomy after NASCET and ACAS: a statewide study. North American Symptomatic Carotid Endarterectomy Trial. Asymptomatic Carotid Artery Stenosis Study. J Vasc Surg 1998;27(6):1017–1022.Google Scholar
181.Cebul, RD, Snow, RJ, Pine, R, Hertzer, NR, Norris, DG.Indications,outcomes, and provider volumes for carotid endarterectomy. JAMA 1998;279(16):1282–1287.Google Scholar
182.Kresowick, TF, Hemann, RA, Grund, SL, et al. Improving theoutcomes of carotid endarterectomy: results of a statewide quality improvement project. J Vasc Surg 2000;31:918–926.Google Scholar
183.Oliver, SE, Thomson, RG.Are variations in the use of carotidendarterectomy explained by population need? A study of health service utilisation in two English health regions. Eur J Vasc Endovasc Surg 1999;17(6):501–506.Google Scholar
184.Ferris, G, Roderick, P, Smithies, A, et al. An epidemiological needsassessment of carotid endarterectomy in an English health region. Is the need being met? Br Med J 1998;317:447–451.Google Scholar
185.Findlay, JM, Nykolyn, L, Lubkey, TB, et al. Auditing carotidendarterectomy: a regional experience. Can J Neurol Sci 2002;29:326–332.Google Scholar