The training of carotid endarterectomy during an era of controversy. A personal experience

: One hundred carotid endarterectomy (CEA) procedures were performed in this teaching institution from August, 1984 to January, 1989 under the direction of the author. Presenting symptoms were TIA (36), CVA (25), amaurosis fugax (17), and asymptomatic carotid stenosis greater than 80 per cent (22). The average age was 61.8 years and 68 per cent were male. The operation was performed through a transverse neck incision with the use of flaps, a shunt was used (96%) and the artery closed primarily (95%). The heparin given was not reversed. There was no operative mortality and the stroke morbidity consisted of one permanent (1%) and one temporary (1%) deficit. Hematoma evacuations were required in four cases; one had a demonstrable bleeding point. The long-term stroke rate was 1.62 per cent, with overall survival of 94 per cent at 42 months. Restenosis following repair was noted in only 5.5 per cent of the cases at one year. When carotid endarterectomy is performed in a teaching institution, excellent early results (2% combined stroke/mortality rate) are maintained long-term. Furthermore, a 50-plus per cent decrease in the risk of stroke at 42 months is demonstrated when this study's results are compared to estimates of the natural history of significant carotid disease.