Results of carotid endarterectomy with prospective neurologist follow-up

Background: Previous studies have shown that neurologic complications following carotid endarterectomy (CE) are underestimated if patients are not examined by neurologists after surgery. Objective: To review the morbidity and mortality in a cohort of patients examined before and after CE in a neurology and stroke clinic. Methods: This was a prospective case series from an academic medical center; 44 patients were referred for CE during the period June 1995 to April 1999. Mean age was 64.3 years; 70.5% were referred for symptomatic stenosis and 29.5% were asymptomatic. Three neurosurgeons and two vascular surgeons operated on the patients. Results: The 30-day mortality rate was 4.5% and the 30-day stroke or death rate was 11.4%. One patient had a TIA due to thrombus formation at the operative site and a second patient;had an asymptomatic intimal flap. Conclusions: With prospective follow-up by neurologists, the CE complication rate in an academic medical center was significantly higher than the rates reported in controlled clinical trials. The generalizability of data from CE clinical trials is limited and local audits are necessary to better establish the risk/benefit ratio for individual hospitals and surgeons.