Carotid Endarterectomy Is Safe, Effective, and Durable, but Can We Make It Better?

The first known carotid endarterectomy (CEA) was likely performed by Dr. Michael DeBakey in 1953. Since that time, the operation has gained widespread approval because it not only effectively reduces the rate of ischemic stroke but also has a relatively low rate of complications. Both the North American Symptomatic Carotid Endarterectomy Trial (NASCET) 1 and the Endarterectomy for Asymptomatic Carotid Artery Stenosis (ACAS) trial 2 demonstrated a significant benefit of endarterectomy over medical therapy alone. Both trials showed durable results with reduced rates of stroke at least 5 years after the operation. The article by Rong et al. recently published in WORLD NEUROSURGERY, “Risk Factors Associated with Ipsilateral Ischemic Events Following Carotid Endarterectomy for Carotid Artery Stenosis,” continues to add to the body of literature demonstrating the efficacy, safety, and durability of CEA. In their study cohort of more than 240 patients with a mean follow-up of more than 50 months, the 5-year risk of ischemic symptom recurrence was approximately 10%. When the authors identified risk factors associated with new ipsilateral ischemic events in these patients, they found that cigarette-smoking, family history of stroke, and atrial fibrillation were all associated with a greater risk of new ischemic events after CEA. Interestingly, symptomatic carotid stenosis was not significantly associated with new ischemic events, although there was a trend toward significance. Only one-third of the ischemic events happened within 30 days of the operation.