Introduction: Long-term outcome data on patients undergoing carotid endarterectomy (CEA) are generally lacking.

Methods: We reviewed a single neurosurgeon’s experience with carotid endarterectomy focusing on long term outcomes. All procedures were performed with primary closure of the arteriotomy.

Results: We studied 108 CEAs, performed from 1998 to 2010 (80% for symptomatic disease). Two patients (1.8%) experienced immediate post-operative strokes. During an average follow-up of 75 months (2-215), two more patients experienced strokes corresponding to their ipsilateral carotid circulation (1.8%) and three (2.7%) experienced ipsilateral transient ischemic attacks (TIA’s). Six patients (5.4%) experienced contralateral TIA’s, and three (2.7%) contralateral strokes. There were also two (1.8%) hemorrhagic strokes and four (3.6%) vertebrobasilar circulation strokes. Notably the Kaplan-Meier ipsilateral stroke-free survival rates at 5, 10 and 15 years were 97%, 95% and 95% respectively (Figure 1). Overall, eleven patients experienced restenosis >50%. The Kaplan-Meier restenosis rates at 5, 10, and 15 years were 87%, 68% and 68% respectively (Figure 2). One patient underwent a redo CEA, whereas another underwent carotid artery stenting. Almost all patients (>95%) were maintained on both an antiplatelet medication as well as a statin.

Conclusions: Carotid endarterectomy provides durable protection from recurrent stroke in the ipsilateral carotid distribution that extends beyond 15 years. This procedure should, therefore, be considered the gold-standard against which other revascularization modalities should be evaluated.

Patient Care: Long term outcomes with carotid endarterectomies are lacking. This report helps understand the benefits of this procedure in the long-term, which may aid in deciding between revascularization procedures

Learning Objectives: By the conclusion of this session participants should be able to describe the long term outcomes associated with carotid endarterectomy

References: Carotid endarterectomy with primary closure: analysis of outcomes and review of the literature. Zenonos G, Lin N, Kim A, Kim JE, Governale L, Friedlander RM. Neurosurgery. 2012 Mar;70(3):646-54; discussion 654-5. doi: 10.1227/NEU.0b013e3182351de0. Review. PMID: 21904262