Carotid endarterectomy : the Maltese experience

Abstract

Introduction: Carotid endarterectomy significantly reduces the risk of cerebrovascular events in both symptomatic and asymptomatic patients with significant carotid stenosis. The recent American Heart Association/American College of Cardiology guidelines advise that carotid endarterectomy is only beneficial when the perioperative stroke or mortality rate is below 6%. The aim of this study was to review the results of carotid endarterectomy performed in Malta by one vascular surgeon. Methods: All patients undergoing carotid endarterectomy between July 2007 and June 2011 were included in the study. Data was entered prospectively into a vascular database. Retrospective review of the case notes of all patients undergoing carotid endarterectomy was also performed. Demographics of the patient cohort as well as information about perioperative mortality, cerebrovascular events, cardiac events as well as any other complications were recorded. Information was also collected about any deaths and cerebrovascular events during the follow up period. Results: 51 patients underwent carotid endarterectomy during the study period. 94% were symptomatic (65% CVA; 15% TIA; 10% amaurosis fugax; 4% TIA and amaurosis) and 6% asymptomatic. 46% had an internal carotid artery stenosis of 90% or more while the rest had a stenosis of 70% or more. 31% of patients also had significant contralateral carotid stenosis or occlusion. There was one postoperative mortality (1.9%) and one patient sustained a postoperative lacunar stroke (1.9%). There were no cranial nerve injuries and no bleeding requiring return to theatre. The combined perioperative mortality and stroke rate in this cohort was 3.9%. Conclusions: The combined perioperative mortality and stroke rate in this sutdy is better than that reported in the major randomised controlled trials. The perioperative death and stroke rate is well below the threshold level advised by the AHA/ACC.