History of Carotid Endarterectomy Then and Now

Abstract

It seems the first successful carotid endarterectomy (CE) was done by Michael E. DeBakey1 in 1953, although the first published report of CE was by Eastcott et al2 in 1954. During the subsequent 2 decades, the number of these surgeries grew. In 1969, the Joint Study of Extracranial Arterial Occlusion, a methodologically imperfect study, reported that, in 2400 operations performed between 1961 and 1968, there was a surgical mortality of 4.5%, ranging from <2% to 36% among the 24 participating institutions, although there was a steady decline in surgical mortality during the 8 years.3 Fifteen thousand CEs were performed in the United States in 1971, and this grew to 34000 in 1976.4 By 1976, my colleague, David Sherman, and I were becoming troubled with the growth in the number of CEs because we were observing patients experiencing ischemic strokes and deaths in conjunction with these surgeries. We were at Southern Illinois University (SIU) School of Medicine in Springfield, IL, observing the good and the bad results of CE. Our medical colleagues often asked us, “What is the complication rate for carotid endarterectomy in our two hospitals?” We replied, “We don’t know.” The time had come to answer the question. We initiated a retrospective study of 228 consecutive CEs during the arbitrary interval from January 1, 1970, to June 30, 1976, in our two 600-bed community hospitals to determine the perioperative stroke and mortality rate. Our primitive methodology is described in the results publication of the study.5 The combined stroke-mortality rate for our series of patients was 21.1% (48 of 228). Eleven CEs were performed for asymptomatic bruits, and the combined stroke-mortality rate was 18.2% (2 of 11). Fifty-seven CEs were performed for transient ischemic attacks in the symptomatic carotid artery distribution, and the combined stroke …