Protocol Improves Safety of Carotid Endarterectomy

Carotid endarterectomy remains an effective procedure despite the introduction of carotid artery stenting. We have established a simple but sophisticated protocol for surgery, management of patients, and education of surgeons to prevent perioperative complications. Using our treatment strategy and education system, we performed 422 CEAs on 372 patients as the first-line choice for carotid artery stenosis between 2002 and 2009. Four experienced surgeons performed 121 procedures, and 15 inexperienced surgeons performed 301 procedures. Surgical morbidity and mortality rates within 1 month were 1.6% and 0%, respectively, for the experienced surgeons, and 1.4% and 0.2%, respectively, for the inexperienced surgeons. Our results are acceptable compared with other clinical studies. The defined procedural protocol, including thorough systemic control, especially prevention of ischemic heart disease, and an education system reduce surgical morbidity and mortality rates, even for inexperienced surgeons.