Carotid artery surgery

BACKGROUND- Carotid atherosclerotic disease is part of generalized atherosclerosis and may remain asymptomatic or present as transient ischemic attacks or stroke. The surgical treatment is endarterectomy. REVIEW SUMMARY- Carotid artery atherosclerosis primarily involves the carotid bifurcation, a surgically accessible site. Since the first report of carotid endarterectomy in 1954, controversy has surrounded this surgery. The clinical presentation of patients with carotid disease, diagnostic testing, and medical and surgical management are reviewed. Selection of patients, practical issues in perioperative management, including the use of anticoagulants, and the timing of surgery for patients who have a completed stroke are discussed. CONCLUSIONS- Carotid endarterectomy has been performed for more than 40 years. The operation is indicated for asymptomatic patients with 60% or more stenosis and for symptomatic patients with 70% or more stenosis, in whom the expected morbidity and mortality are less than 3% and 6%, respectively. Careful patient selection is critical to outcome. Long-term management remains risk factor control.