What are the current operative risks of carotid endarterectomy?
Carotid endarterectomy (CEA) reduces the risk of stroke in patients with recently symptomatic severe carotid stenosis and to a lesser extent in patients with recently symptomatic moderate stenosis or severe asymptomatic stenosis (1-4). However, the procedure has a relatively high rate of complications, which limit the benefit of surgery in patients at low and moderate risk of stroke on medical treatment alone. Reliable data on the risk of CEA in relation to clinical indication are necessary to target surgery more effectively, to properly inform patients, to adjust risks for case-mix, and to understand the mechanisms of operative stroke. This chapter will briefly consider what we know about the overall operative risk of CEA and how the risk is related to the clinical indication, the characteristics of the patient, and the timing of surgery. Other important issues, such as surgical technique (e.g., patching, shunting, monitoring, etc.) (5-7), surgical workload, and experience, and type of anesthetic (8) are covered in other chapters.