Carotid Endarterectomy in Symptomatic Extracranial Internal Carotid Artery Stenosis: A Result of the First 100 Consecutive Cases in a University Hospital
Pramook Mutirangura MD*, Chanean Ruengsethakit MD*, Chumpol Wongwanit MD*, Nuttawut Sermsathanasawadi MD*, Khamin Chinsakchai MD*, Suteekhanit Hahtapornsawan MD*, Kiattisak Hongku MD*, Nuttawut Puangpunngam MD*
Affiliation : * Division of Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Extracranial carotid artery stenosis has been recognized in 9.2% of ischemic stroke patients by duplex
ultrasonography in Thailand. The treatment program of this disease has not been established countrywide.
Objective : Carotid endarterectomy in our institute was firstly evaluated for safety and long-term efficiency in order to assess
the possibility of expanding this treatment throughout the country.
Material and Method: An observational study with long-term follow-up was carried out in 100 consecutive symptomatic
patients with severe stenosis (70-99% diameter stenosis) of extracranial internal carotid artery that underwent carotid
endarterectomies. All carotid endarterectomies were performed under general anesthesia, with routine use of intravascular
shunts during carotid cross clamps and saphenous vein patches for arteriotomy closures. Perioperative mortality and
morbidity were evaluated for the safety of this procedure. The long-term stroke-free survival was assessed to announce the
efficiency of this treatment.
Results : One hundred consecutive patients (68% male and 32%female) with the mean age of 69.9 years were included in
the present study. Mean duration of neurological symptoms prior to surgery was 2.5 months. Hemiplegia (64%) was the
most common symptom leading to surgery. Hypertension (87%) was the most common comorbidity in the present series.
Mean duration of surgical procedure was 210 minutes. Mean durations of total carotid shunting and carotid cross clamp
during shunt removal were 75 minutes and 4.5 minutes respectively. Mean length of ICU stay was 1.4 days. The perioperative
mortality rate was 1%. The perioperative major stroke rate was also 1%. Ten-year follow-up of the patients revealed no
death related to neurovascular event and no evidence of recurrent ipsilateral stroke in the present series. The cumulative
5- and 10-year stroke-free survivals were 86.1% and 73.7% respectively. Duplex ultrasonography in all survivors
demonstrated no recurrent stenosis in the affected carotid artery.
Conclusion : Carotid endarterectomy with a consistent technique in the present series had a comparable outcome of safety
and long-term efficiency with the standard surgical practice. The information may initiate the treatment guideline for the
patient with extracranial carotid artery stenosis in Thailand.
Keywords : Carotid endarterectomy, Carotid artery stenosis, Stroke
