July 1992

Results of Staged Bilateral Carotid Endarterectomy

Author Affiliations

From the Departments of Surgery, University of North Carolina School of Medicine, Chapel Hill (Drs Maxwell, Clancy, and Tackett), and New Hanover Regional Medical Center, Wilmington, NC (Drs Maxwell, Rutherford, Clancy, and Tackett); and Area Health Education Center, Wilmington, NC (Drs Maxwell, Clancy, and Tackett and Mss Covington and Churchill). Dr Rutherford is now with the Department of Surgery, Vanderbilt University, Nashville, Tenn.

Arch Surg. 1992;127(7):793-799. doi:10.1001/archsurg.1992.01420070049011

• To determine differences in outcome between unilateral and staged bilateral carotid endarterectomies, we reviewed 850 carotid endarterectomies done by 14 surgeons in a community hospital. Results of 528 unilateral procedures were compared with those of 161 bilateral procedures. Data were abstracted from records for an 11-year period. Twelve of the patients in the unilateral group had nonfatal strokes, and 14 died within 30 days of surgery (stroke+death rate, 4.9%). There were no nonfatal strokes among patients in the bilateral group, and nine died (stroke+death rate, 5.6%). Seven of 14 deaths in the unilateral group and six of nine deaths in the bilateral group were due to neurologic events. In the bilateral group, death was associated with postoperative hypertension and a short intersurgical interval. The stroke+death rate was not significantly different between unilateral and bilateral procedures and compared favorably with North American Symptomatic Carotid Endarterectomy Trial guidelines and other published reports. Staged bilateral carotid endarterectomy can be safely performed in a community hospital.

(Arch Surg. 1992;127:793-799)